Life brings about a lot of change. Change may feel welcome to some, and it may feel traumatic to others. When reading chapter 9 (ATTACHED), were there any of vignettes that resonated for y

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CHAPTER 9

Developmental, Transitional, and Situational Crises Throughout the Life Span

Shane Haberstroh, Katherine A. Feather, and Madelyn Duffey

As we explored in previous chapters, catastrophic events arise in the lives of people every day. Counselors trained in trauma-informed approaches and equipped with basic disaster mental health and crisis counseling tools can

work to provide compassionate care and connect people with needed resources. Other times, people seek counseling when situations exceed their trusted and fa- miliar ways of coping and living life (James & Gilliland, 2017). Throughout the life span, people experience many stressors that invade their lives with toxic stress and uncertainty but do not rise to the threshold for a posttraumatic stress disorder (PTSD) diagnosis.

Chronic mental or physical issues, disorienting life events, expected and un- expected losses, developmental and identity transitions, new situations, and illnesses and role stressors can wear down people’s capacity to cope. Expected life transitions may feel bittersweet, and unexpected events can shake individu- als deeply. As people mature, families, friends, and communities also grow and change, and not all change is growth oriented. Sometimes groups, people, and loved ones seem to devolve into chaos. However, although crises and transitions can leave people shaken, they can also serve as a point of reflection and beginning of personal growth.

The Relational Foundation: Integrative Perspectives People do not develop well in isolation, disenfranchisement, and disconnection (Jor- dan, 2018). Attuned counselors emphasize a relational core at the heart of human de-

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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velopment. When clients encounter troubling times, the quality of their relationships can either mitigate their pain or exacerbate their situations, and the therapeutic rela- tionship can serve as a strong and reliable alliance. In fact, voluminous research sup- ports the power of the counseling relationship (Wampold & Imel, 2015), reporting that the quality of the relationship, as experienced by clients, is the most powerful predic- tor of growth (Wampold & Imel, 2015). Research indicates that the healing relational qualities in counseling supersede technical approaches and serve as the foundation for many manualized treatments (Wampold & Imel, 2015). Given the primacy of our therapeutic connections, our relational intentionality and clarity shape the experience of the counseling relationship and process for us and our clients.

Integrative Considerations When working with people who face new life roles, stressful life events, and abrupt planned and unplanned changes, counselors integrate relational principles and practices, grief models, trauma work, and crisis counseling approaches to concep- tualize losses in context and to harness shared creativity to inspire some practical solutions. Within this chapter, we explore relational processes, integrative frame- works, and practices that guide our understanding of life crises and transitions.

Relational Process

The experience of mutual empathy (Jordan, 2018) demonstrates our understanding of a person in their context. Knowing you really matter to another human being can break the bonds of exclusion and private suffering. As we discussed in Chap- ter 3, microinvalidations accentuate differences and further alienate people from one another. As counselors, we may partner with people who have more social privilege than we do. Alternatively, we may work with others whose social loca- tion mirrors ours, and we may also connect with people who endure a life of scar- city and oppression. As counselors, our ethical principles place our clients’ welfare first (American Counseling Association, 2014), and we should invest the energy to understand a person’s world and pain as they experience it.

A Life and Identity in Context

Destabilizing life events occur within work, family, and broader social contexts. Within all social strata and systems, constellations of power, privilege, oppres- sion, and rejection exist and cause distress and isolation. By example, many people commit suicide who seem successful (Centers for Disease Control and Prevention [CDC], 2018), and numerous deaths by suicide seemingly have no clear precursor. Moreover, a significant number of people commit suicide when faced with life cri- ses and relational strife (CDC, 2018). These statistics speak to the miseries people experience, how seeming success does not protect individuals from the deepest pain, and how shame and the pains of life can seem unsurmountable. In other words, a person’s pain, confusion, and anxieties make sense in their context.

Perspectives on Loss

Theories of grief chart life experiences during and after losses. When conceptual- izing chronic and transitional life stresses, we consider how people move between

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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the sharp anguish of their loss and living a new and unknown life. The dual process model (Stroebe & Schut, 2010) of grief work highlights the untidiness of change. Individuals may find themselves feeling sorrow one moment, hope in the next, and confusion in between. This process normalizes and validates the seemingly chaotic feelings around transitions and stressors and stands in contrast to messages people receive that urge them to move on or get over their situation and feelings. These messages ignore the fact that people’s losses are part of their stories. People often live with pangs of loss while charting a new life framed by their memories and ex- periences. See Sidebar 9.1 for more information on the grief process.

Mobilizing Resources

A life crisis is a new territory where people can feel lost and alone. People can be stretched beyond the strategies and relationships that sustained and comforted them through many other life experiences. Given that crises upend familiar ways of being in the world, prepared counselors can help clients chart a new life course and explore valuable information and connections within the community. As counselors, we stay abreast of community resources and network with partners in the community who of- fer specialized services. We develop resources and explore groups that provide finan- cial planning, employment support, medical practice, and legal issues. For example, when we worked to develop the Sutherland Springs coordinated response grant after the mass shooting, we partnered with multiple agencies, law enforcement, legal ser- vices, schools, and social service agencies to support people dealing with their trauma but also the exacerbated and interrelated stress that emerged. When we develop com- munity partnerships and share accurate and helpful information for clients, we can help customize their map to navigate the stresses and confusions of this new territory.

Crises of Identity Development Developmental transitions, growing self-awareness, social pressures, and stressful events can strike the heart of people’s identity. As people learn about who they are, their awareness is influenced by societal expectations, their demographic and cultural backgrounds, and interactions with the world. Developmental crises oc- cur throughout life, and many traditional developmental theories often describe human growth in a linear or task-oriented manner. From these perspectives, iden- tity crises may result from failing to meet developmental milestones, unsuccessful self-individuation, or dissolution of ego strength (Jordan, 2018).

The notion that people’s identity is multifaceted and a convergence of many factors (Gemignani & Hernández-Albújar, 2019) highlights that their sense of who

Sidebar 9.1 • Grief Process The grief process used to be viewed as a linear process, and people were believed to move through each step before they could get to the next. Although grief can follow this process, current literature talks about how grief is different for everyone and does not always follow a certain path. Have you ever experienced grief or a big change? Did you ever feel like you took two steps forward and one back?

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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they are grows from an intersection of roles, cultural influences, power positions, earned and unearned privileges, and their own unique histories. Although an in- tersectional identity speaks to a person’s diversity and uniqueness, we are acutely aware that many people experience subtle and overt forms of racism, bullying, op- pression, and stigmatization, especially when they appear different or experience shame in their social circles.

People’s multiple identities are vibrant expressions of their whole personhood. Intersecting identities or intersectionality signifies the interrelated nature of social classifications such as race, ethnicity, class, nationality, gender, sexual orientation, religion, age, and disability as they apply to an individual or group, as well as how people with privileged and stigmatized identities experience these interconnect- ing systems (Ching, Lee, Chen, So, & Williams, 2018). Counselors help clients rec- ognize, as well as label, everyday psychological distress stemming from systemic, rather than personal, flaws and encourage clients to embrace their connection with others to build resilience against oppression (Ching et al., 2018).

Ultimately, the work of counselors is to appreciate clients’ multifaceted intersec- tions and contexts; integrate our knowledge into crisis response care; and work to dismantle forms of oppression at the individual, community, and societal level. All of the transitions and situations we highlight in this chapter speak to life and role stressors that entangle themselves in role expectations and personal and social identities, potentially leading to feelings of isolation and chronic anguish.

Childhood and Developmental Stressors in a Family Context

“I’m afraid the thing that is broken in me is also broken in him,” Rick said as he told the story of his 10-year-old son, Jacob, who was being bullied at school. Ja- cob’s parents felt helpless as they watched their son withdraw into himself after being sent to the office repeatedly for throwing his classwork in the garbage in frustration. “It’s like he has crumpled in on himself,” his mom, Jeanne, shared. “Maybe it’s us? Maybe he can sense somehow what’s going on. He won’t tell us anything.” As they spoke more about their circumstances, they shared a story of multiple and compounded life crises. As they watched their son wither, met with school administrators who responded with legalese instead of compassion, and felt their own emptiness and fears blossom, they had to also navigate several per- sonal and familial losses. A week after they decided to separate, Jeanne’s physician referred her to an oncologist.

Considering this situation from a relational perspective, we consider Jacob’s social context. We explore how he may be experiencing power abuses at school. We discover his experiences with peer and teacher relationships. We validate that when he reaches out to his parents, even in the smallest ways, he is showing re- lational resilience. We also move from the idea that something is broken within Jacob and Rick to exploring disconnections, power in context, and isolation as our primary focus.

Watching a child suffer is heartbreaking. It can leave us feeling lonely, frustrat- ed, and powerless. Recent data from the National Center for Education Statistics (2019) indicated that nearly 7 million children receive special education services in the United States. These numbers do not account for the estimated 20% of young

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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children who also suffer from a mental health issue such as depression or anxi- ety. Frequently, children who struggle with mental health issues do not receive adequate services (Whitney & Peterson, 2019). As schools continue to budget to deliver adequate programming, families and children may miss much needed ser- vices and begin to lose hope.

The cumulative impact of early adverse childhood experiences often leads trau- matized children to be diagnosed with multiple and often inaccurate diagnoses. Researchers at the National Child Traumatic Stress Network conducted several studies (van der Kolk, 2014) related to the impact of multiple childhood traumatic stresses. They concluded that a vast majority of children in their studies experi- enced multiple traumas, and many of them did not reach the threshold for PTSD for any one event (van der Kolk, 2014).

A team of researchers and clinicians sought to include developmental trauma disorder (DTD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013); however, the DSM review team rejected the proposal for inclusion (van der Kolk, 2014). The move to include DTD as a diagnostic category represents an epistemological shift in the view of trauma- related disorders to a social malady rather than a dysfunction within a person. That is, DTD would be drastically reduced by the elimination of social contexts that foster child abuse, assault, chronic maltreatment, poverty, bullying, and the many faces of neglect. Developmental traumas can influence a person’s growth by limiting their experience of nurturing relationships and growth-oriented relational bonds (D. J. Siegel, 2012).

Parenting Children With Disabilities: A New “Normal”

The added demands of raising a child with a disability is a source of significant stress and can shift the foundation of the whole family (Dabrowska & Pisula, 2010; Guralnick, Neville, Hammond, & Connor, 2008). As parents learn that they will not be raising a neurotypical child, they may experience stress adapting to their new and unexpected roles. Such adjustments include coping with disappoint- ment, guilt, uncertainty, and grief (Neely, Amatea, Echevarria-Doan, & Tannen, 2012; Sheehan & Guerin, 2018). It is important to note that painful feelings can decrease with time, but grief can be triggered by both internal and external fac- tors. Triggers are often related to developmental milestones (e.g., starting school, graduation). These situations resurrect feelings of loss that occurred when their child was first diagnosed. When these milestones occur, caregivers may be faced with the difference between their imagined or hoped for future while facing the realities of loving a child with a different ability.

Many parents strive to create supportive and nurturing environments for their family and child, but many are never told how. The joys and challenges of parent- ing a child with a different ability can be stressful because of the complex needs of the child and caregivers. Families who receive little instruction on how to best meet their responsibilities face an increased risk for psychosocial distress and physical health problems (Resch, Benz, & Elliott, 2012). Fortunately, counselors can work with parents through these times, sharing the burdens and helping the fam- ily learn practical strategies for living (Hohlfeld, Harty, & Engel, 2018). However,

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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before addressing psychoeducation and skills training, we build trusting relation- ships with the parents (Sheehan & Guerin, 2018). Counselors play a dynamic role in supporting parents of children with different abilities and promoting greater life satisfaction. Some helpful recommendations for counselors working with this population are presented next.

Parent Education

Caregivers understand their child’s physical, social, developmental, and family history better than anyone else and are respected and valuable partners in the counseling process. Counselors offer information specific to parenting a child with specific needs as well as the accurate facts about disability, validate and normalize the adjustment process, and offer linkages to resources in the community. Coun- selors appreciate how language can disempower and humanize the child and their family. For example, counselors need to avoid disempowering terminology, “Your autistic, handicapped child,” and instead use more empowering language (i.e., use the child’s name; say “people with disabilities, different abilities”; or ask how people wish to identify themselves), honoring the idea that a disability is only one aspect of a person’s identity. Finally, we educate and support parents, help- ing them develop their assertive communication and advocacy skills, which may serve them in many situations (e.g., pre-K–12 school systems, medical practices, and within their community).

Skills Training

Early intervention and skills training set the foundation to build on a child’s po- tentials for developmental, social, and functional growth (Hohlfeld et al., 2018). We teach parents techniques and skills and connect them with helping specialists in their community. For example, Stepping Stones Triple P (Positive Parenting Pro- gram) is a leading prevention program that supports parents with children with disabilities by providing skills and principles to help parents cope with behav- ioral and emotional upheavals (Ruane & Carr, 2019). This program also educates parents on how to (a) adopt an assertive approach to discipline, (b) adapt to the reality of their child’s disability, (c) establish realistic expectations about the devel- opment of their child, (d) link children in in a shared community, and (e) practice effective self-care (Ruane & Carr, 2019). For an exhaustive summary of marriage, couples, and family counseling interventions for autism spectrum disorder (ASD), see Feather (2016).

Parent Environmental and Social Support

Counselors share resources and connect parents with services in the community and tailor social services for children. Parents who join with social supports report- ed higher levels of well-being, and they appreciated the tools and shared resources provided by people facing common concerns (Hohlfeld et al., 2018). Parental well- being and family adaptation is tied to social connections, in which individuals in the network offer emotional support and provide experiences and solutions about various problems (Guralnick et al., 2008; Resch et al., 2012). I (Katherine) have found through my conversations and research with mothers of children with ASD

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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that they often treasured the connections with others who understood their situa- tion. These mothers felt relieved because they were no longer alone and could ex- press their experiences with another parent. See Sidebar 9.2 for more information on parent education.

Parent Well-Being

When people manage the many routine stresses of parenthood, coupled with the unique stressors facing parents of a child with disability, wellness may dwindle because of the nature of these circumstances. Given that these stresses may settle into a family’s life permanently, the chronic stress can take its toll. Isolation may increase as a function of their many roles and responsibilities. Parents’ needs for nurturance, self-compassion, and connection may not be met because of the sun- dry associated tasks (Dabrowska & Pisula, 2010). Parents who share in a commu- nity of support gain access to helpful information and services and often experi- ence higher levels of overall well-being (Resch et al., 2012). Therefore, counselors develop resources and information to reduce distress and increase parent well- being. Practical efforts and social connections reduce systemic distress and can support the family and child as they navigate developmental milestones and po- tential behavioral issues; these connections also provide parents with meaningful support (Guralnick et al., 2008).

Additional Stressors During Parenthood

Adjusting to Parenthood

Nguyen always wanted to be a mother. Her husband, Eric, was less enthusiastic about the prospect of parenthood. Although Eric was open to the idea of hav- ing a child, he could not imagine having one anytime soon. He worried about undertaking the responsibility of a new life and the lifestyle changes that come with children. After discussing the possibility of adding to their family for 2 years, Nguyen and Eric decided to move forward. Pregnancy proved difficult, but the couple conceived through in vitro fertilization. Despite Eric’s initial hesitancy, he was an attentive partner, and the two prepared for the arrival of their new baby, Amelia, as a team. He and Nguyen decided that she would stay home until Amelia began primary school.

Although Nguyen expected a difficult labor, and acknowledged hers as being painful, she described her labor as otherwise uneventful. After dreaming of being

Sidebar 9.2 • Parent Education Throughout this chapter, we include resources for individuals wanting more information about parent education and parent well-being. Creative outlets may also help families express their experiences and strengthen their connections with each other. Some examples of these activities include dancing, gymnastics, team sports, music, and painting. These outlets could connect a child with other children through creative expression, and the parent could also connect with other parents sharing similar experiences.

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-02-28 03:55:16.

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a mother for years, Nguyen was hopeful that she would find joy in her new role. Much to her surprise, although there were moments of joy in new parenthood, and she loved Amelia fiercely, she struggled considerably. Nguyen had difficulty breastfeeding and felt criticized when she decided to stop. Lack of sleep severely affected her mood and lucidity. Eric also struggled with sleep, and the two began to argue frequently. Nguyen also realized that she was quicker to anger with her friends, and she often felt overwhelmed by small tasks. Little things she used to take for granted, such as time alone and moments of silence, seemed like part of her past. A meticulous researcher and planner, Nguyen expected many of these struggles. What caught her off guard most was a powerful sense of loss, anger, and isolation. Nguyen had fought to be a mother, so why did she still dream of her old life? Every life stage can bring a mixture of feelings, and parenthood is no excep- tion. Becoming a parent is a massive transition in many people’s lives. This was the case for Nguyen. Even though she desperately wanted and loved her child, adjusting to motherhood was turbulent.

Parents who eagerly anticipate the birth of their newborn may feel a mixed sense of joy and loss after the baby’s arrival. These sentiments are not always societally understood, and new parents can feel pressured, and even judged, when they com- municate frustration and discomfort. New parents accustomed to pleasing others or presenting well in public may hide these struggles. Relational-cultural theory de- scribes this form of hiding as antithetic to authenticity (Jordan, 2018). In relational- cultural theory terms, authenticity relates to being able to represent oneself fully and freely (Jordan, 2018). Therefore, hiding, which is opposite to authenticity, may create a crisis of meaning and belonging for new parents. New parents like Nguyen may love their babies deeply and also profoundly miss their friends, activities, and—as Nguyen indicated—“the quiet stillness” she once took for granted.

Like Nguyen, new parents may feel shame over their developmentally appropri- ate, yet socially invalidated, emotions, and they may keep these feelings to them- selves. Doing so increases their chances of isolation. In addition, financial stressors may also exacerbate parents’ adjustment to parenthood. Although parents may be overjoyed by a recent birth, they may also feel particularly stressed and conflicted when economic challenges arise. In some families, a tenuous medical history may prompt parental concerns with the anticipated birth of a child, and they may feel alarmed and fearful over their child’s future physical or emotional health. In those cases in which the pregnancy was not expected, the prospect of parenthood can be perplexing. For parents who suffer a traumatic childbirth, these adjustments can be particularly challenging.

Traumatic Childbirth

Caroline and her husband, Stewart, celebrated their eighth wedding anniversary by painting a nursery in preparation for the birth of their first child. The couple met as student athletes in college, and after years of building their careers and nurturing their relationsh

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