Sunday, November 25, 2012

Therapy Behind Enemy Lines


Working as a wraparound therapist in one of the harshest milieus any could ever encounter is a struggle most would equate to that of Sisyphus, the poor Greek wretch doomed by Zeus to roll a large stone up a hill only to have it fall back down moments before reaching the top, then forced to begin again, each time unsuccessful, but rolling for all eternity. I have more recently likened it to battlefield therapy, much like military medics administering care in the heart of the warzone, amidst artillery and death. We run out, bullets zipping overhead, into dangerous neighborhoods and torn communities and homes, and try to provide treatment to crumbling soldiers on the precipice of total collapse. How can efficient care be given and progress be made in such a tumultuous state of affairs? How can we make a difference?

Most times clients are referred to wraparound for some traumatic event, or a string of events that have contributed to some degree of emotional or psychological unrest. This is where treatment begins, on the frontlines, addressing the core issue, tying the bandages on and attempting to alleviate the symptoms, fostering some sliver of healing.  Back in the trenches, you try to wrap the family in a splint, giving them a support to lean on as you repair the damage of their broken structure and disinfect the festering wounds in the system in order to facilitate the healing in your client. Soon, you see improvement, softening scar tissue, subsiding sepsis, recovery.

Then, BOOM! Before you know it you are rocked from the mild relief of progress and the small infrastructure you’ve built from ground zero shakes, rocks, then crumbles. Tragedy strikes the family, the client, or the community, and it sends shockwaves through the souls you’ve worked so hard to strengthen. The bomb drops in many forms in the ghetto, but most times it’s usually violence. One bomb dropped not too long ago was a nuclear warhead of sorts. A client and her family, not one I had worked with, lost a sibling, lost a child to gang violence. The family was understandably temporarily demolished; the client thrown back from the blast to a state of regression. But, as nuclear warheads do, the radiation soared through the community, a poison seeping into homes like the black plague. One of my clients was considerably close to the deceased, which brought a surge of trauma as we had been processing the loss of her brother to gang violence that had taken place so many years ago. Another client who had lost her godfather to violence in the hood was distant cousins with the deceased. Progress made in many camps was transgressed and had to be quickly addressed to avoid utter devastation.

The common diagnosis soldiers leave the battlefield with is Post-Traumatic Stress Disorder, but what I’ve come to find is in treating these clients, PTSD is hardly appropriate as the key word in the preceding phrase is “leave.” One must leave the battlefield, or rather be removed from the trauma in order to have post-traumatic stress. So many of these clients are still exposed to that trauma daily; the focus of one client’s treatment was directed towards minimizing a preoccupation with death and fears of dying prematurely. As we gradually made progress, he found himself staring down the barrel of a gun when a young gang member approached him and threatened his life, which sent him stumbling back. Months later after more work, he found himself faced with another gun when two young thugs woofed at him on the streets in a brief attempt to intimidate. Days later he was held at gun point by local law enforcement during a case of mistaken identity when they were patrolling for a young suspect in the area. Likewise, we work with Commercially Sexually Exploited Children (CSECs) or human trafficking victims. In the safety of group homes or jail where they usually end up, most CSEC clients are more protected. Returned to their homes and communities where they were recruited into the life, they stew in traumatic stress as the circumstances that drove them from their homes and into the streets are still ever present, and their pimps lurk behind every dark corner just blocks away, waiting to snatch them up for service again.

If you think such occurrences are possible in any client’s life, you’re right. Any one of your clients may be faced with tragedy during their journey on the couch, one that may be entirely unrelated to past events, current disruptions, whatever they have sought your services for, but one that could dissemble the work you have achieved together in a matter of minutes. However, if you think the possibility of such occurrences is proportionate to all clients of all demographics, you are sorely mistaken. Living in certain climates, such as that of the ghetto, places one at a significantly higher risk of experiencing some alternate trauma in the bog of their original trauma. And sometimes the bomb being dropped is not trauma at all, but another obstacle that prevents the client and the family from progressing up the hierarchical pyramid of self-actualization, such as the loss of food stamps, the cessation of unemployment benefits, the rejection of SSI, eviction, the loss of Medi-Cal, which again, is more prominent in the ghetto. Many times the clock of progress is set back when the focus becomes survival rather than mental and emotional well-being. Without basic needs such as food and shelter, safety and security, health and happiness fade into the darkness as a luxury, not a necessity.

Working in such an environment has its impact on the clinician as well, for you sustain every blow delivered to the clients and families you work with. When bandaging a leg, your patient gets shot in the shoulder, and a slug may nick you in the cheek. Rolling your rock, frustration is a close friend as every step forward you take, you risk stepping on a land mine and every benchmark you achieve may not even exist tomorrow. After you retreat from the frontlines for the day and take a few breaths back at the base, you find yourself wondering if the battle will ever end for them. And you wonder how much more of the madness you can bear yourself.

However in spite of so many setbacks and so many struggles, there is notable progress in these cases. It would be a fantastic dream to hope for perfection and a euphoric utopia, but at times, reaching functionality is the zenith of success in these families. Instilling resilience in the face of adversity rather than expecting that the adversity would dissipate, fostering strength and self-efficacy necessary in battle rather than driving away the dark forces of inevitable war, and planting seeds of hope and dreams in a field of cold, stony debris is what keeps these people going. It allows them to rise out of the trenches, if only for a moment, to enjoy the quiet of the early morning hours before the resounding trumpet resonates through the bunkers, to feel the warmth of the new day’s sun on their face before it is reddened with smoke, and to fight another day. And it is this that keeps you going. I often have to remind myself that this is not typical therapy. Far removed from the safety of a stationary clinic in a middle class neighborhood, the experience is both harrowing and invaluable. Should we survive it, we will have been prepared for any feat in the future of our careers.