Sunday, February 8, 2015

Safety Checklist: Before, During, and After Flashbacks

Your partner has PTSD, you might or might not. This is a world that is most likely foreign to you, filled with chaos that seemingly comes out of nowhere and brings about a host of reminders of problems that might have happened long before you two met. Whatever happens during a flashback or a trigger, it is important to seek understanding. The first thing that you can do to start to understand is to validate the other person. Even if the person is remembering something that happened differently than what you remember, validate it. To them, it is true.

Ask about it. Even when symptoms are highest, talking about what's going on might prove more helpful than detrimental. Our natural human instinct is avoidance (and I'm often guilty of this). If the time is right, it might help to sit down and discuss the degree of symptoms and offer support. Be careful here, as this is getting into dicey territory. It only takes a few phrases that can make the difference between a thoughtful and open conversation and the catalyst to a blind rage or intensified flashback. Ground your partner by saying things that are happening around you—the state of the weather, a pet running across the room, children talking, or even asking if your partner can hear you. When a survivor is having a flashback, they have no awareness of their surroundings. It's like they're there, but not really there [a future post on the role of dissociation is coming soon]. A few things that have helped with my wife and me has been calling out a term of affection for my wife, asking if she is going into flashback mode, or asking if she can see or hear things that are going on. Every situation is different, so you'll need to play each situation by ear: It is as important to talk about it as it is to give the other person the space they need. Sometimes talking about things afterwards makes for a better conversation. Always maintain that your partner has control.

PTSD comes out of trauma that is out of the person's control, so make sure that during elevated times of symptoms, triggers, and flashbacks that you communicate that the other person is in control. During these times, safety is the utmost priority and should not be compromised—period. If your partner tells you to stay away, back off. If your partner is belligerent, calmly validate the things they are saying, and calmly reassure that you are there for them. Do NOT under any circumstances threaten the safety of the survivor; it will only escalate the survivor's symptoms. When your partner is in flashback mode, it can seem like a minefield, but stay the course and watch what you say and do. It will pass eventually. If the flashback hasn't lifted for a few hours, it might be time to call a mental health crisis line or 911. If the survivor threatens the safety of themselves or you, it's always important to call 911.

Living with someone that has PTSD presents a new set of challenges to a relationship, so it's extra-important that communication be as strong as possible. My wife and I remind each other often, "Don't forget your Vitamin C [C meaning communication]." It helps us immensely, especially when her symptoms are high.

A concise checklist summarizing what was said above follows:

Before flashbacks begin:
1. Ask your partner if they are still in the present. Ask if they can hear things, see things, smell things that are going on. Help them by grounding them in what's going on around you.
2. Prepare a "grounding box"—together. Include things that will help your partner remain in the present as much as possible. Remember, the survivor is in control, and they know themselves best.
3. Be sensitive to their requests. If they need some space, give them space. If they need some alone time, give it to them, but check in every once in a while to make sure they're okay. Never threaten them or disrespect what they ask for when it comes to space or time apart, but don't abandon the situation, either.

During flashbacks:
1. DO NOT try to take control. You're now in the supporting role. Your job is to bring your partner back. Talk about what you see, ask what they're hearing, seeing, or feeling.
2. If they become physically belligerent, back off.
3. If things get too prolonged or unsafe, call 911 or a mental health crisis line.

After flashbacks:
1. If the mood permits, talk about what happened. Ask again if your partner is in the present.
2. Discuss possible prevention measures you both could have taken.
3. If you don't have a conflict management system in place, discuss it (I'll write about one in a future post).

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