Day: March 24, 2023

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Helping Out a Friend Through a Mental Crisis Using ALGEE

Have you ever heard of the statement “That’s what friends are for”? It implies the role of a friend as someone you can count on to help you out. So when a friend reaches out and opens up about a problem, it seems natural to listen, comfort, and support them as best as you can. But there are times when you may not feel confident enough to help them. You may feel like you don’t understand the problem very well because you have not experienced it, or you have probably dealt with a similar problem before but could not understand why your friend is struggling with it. Sometimes, the idea of saying something wrong and making things worse for your friend is daunting in and of itself. Fortunately, there is one way for you to help your friend in times of mental distress.

So how can I help my friend out?

Like with medical concerns, you can provide first aid for mental health concerns.

Mental Health First Aid (MHFA) is done to help someone experiencing a mental health crisis when professional help is not yet available. ALGEE is a tool that is used to provide MHFA. It won’t teach you how to become your friend’s personal therapist, but it will help you provide them with the support they need to cope with what they are going through in that moment of crisis.

ALGEE is an acronym that stands for the following: Assess for risks of suicide or harm; Listen without judgment; Give reassurance and information; Encourage appropriate professional help; and Encourage self-help and other support strategies.

How do you use ALGEE?

ALGEE can be done in any order, depending on what you think your friend needs at the moment. Below is an overview of how you can approach and what you can expect to happen in each step. 

1. ASSESS for risk of suicide and harm

This step involves observing for any signs that would tell that a person is in distress. Such signs can be a sudden change in behavior or an unusual reaction to a particular topic or situation. You should also be alert to mentions or jokes of your friend contemplating suicide, as well as self-harm behaviors such as cutting, engaging in excessive substance use (such as alcohol, cigarettes, or drugs), or doing risky activities that can harm them physically.

If you find out that your friend is actively hurting themself or has plans to commit suicide, then it is important to persuade them to get help as soon as possible.

2. LISTEN without judgment

People who are in distress want to be heard. That’s why it is important to give them the opportunity to say what they want to say uninterrupted. Keep an open mind about what they are saying, even when you do not agree with them. Avoid making speculations or giving advice, unless your friend specifically asks for your opinion on the matter.

Show that you are actively listening by keeping an open and receptive body posture (that is, arms and legs uncrossed and palms resting comfortably on the lap or desk) and maintaining eye contact. You can also make appropriate verbal responses to show that you understand and follow what they are saying. Responses may be in the form of reinforcements (“I see.” or “Uh-huh.”), acknowledgements (“That’s tough.” or “I can imagine how confusing it is to be in that situation.”), questions (“What did you do to cope with that situation?”), and reflections (“This is what I heard from you. Am I understanding it correctly?”). If you’re talking with your friend through text or chat, you may need to rely more on verbal responses to better understand each other.

3. GIVE reassurance and information

In an effort to cheer your friend, you may sometimes find yourself telling them that everything will be okay or that they can do things if they only believe in themselves. However, people in distress may feel so overwhelmed and hopeless that they cannot see their situation improving or believe that they can act on their problems. To give reassurance, you need to make them see the possibility. You can do this by providing evidence and information. Are there ways to deal with their problem that they may not have thought of? Have there been situations that contradict a negative thought that’s been running through their mind? Helping them find evidence that there are things that can be done is an effective way of instilling hope in them.

There may be times when your friend thinks that undesired feelings or behaviors, such as lashing out at other people or being too afraid to speak in public, are their fault. However, such feelings or behaviors may actually be symptoms of a particular mental illness or of significant distress that could lead to a mental illness if untreated. Thus, it is important to emphasize that mental illness is real and the symptoms they are experiencing can be treated with the right help.

4. ENCOURAGE appropriate professional help

The earlier your friend gets help, the more likely they can recover. Find out what kind of support your friend needs at the moment and help them find professionals, agencies, organizations, or institutions that can make things a little easier for them.

If they need psychological help, there are various mental health services and programs available. Some universities and organizations offer free therapy sessions, although they may be limited in terms of slots or the number of sessions that can be availed. For long-term and more intensive help, paid therapy sessions in clinics and hospitals may be necessary. You can check out the directory of mental health facilities in the country created by #MentalHealthPH here. Additionally, 24/7 crisis lines come in handy whenever there is a need to overcome a mental crisis or to prevent a suicide attempt. A list of these hotlines can be found here. Regardless of whether payment is involved, simply being able to attend therapy is already a huge step towards healing.

5. ENCOURAGE self-help and other support strategies

Mental health services aren’t always available, and this can be a problem when your friend experiences a panic attack or suddenly feels overwhelmed by suicidal thoughts. Knowing how to deal with these emergencies helps them develop the skills to cope with crises on their own. Coping strategies such as breathing, grounding, and self-soothing techniques are useful during panic attacks. Utilizing tools for mindfulness and emotion regulation also helps practice control and lessen chaotic situations caused by outbursts. Exercising, spending time with friends and families, and engaging in hobbies and other recreational activities can help improve one’s quality of life. For some mindfulness breathing exercises, you can check out Circle of Hope’s Hingalangin videos on their Facebook page.

To see a demonstration of ALGEE, you can watch this roleplay video on YouTube.

Are there things I should consider when using ALGEE?

As a mental health first aid tool, the main purpose of ALGEE is not to diagnose your friend or solve their problem, but to help determine their needs and provide appropriate support. While your closeness can help your friend be more comfortable opening up to you, it is important to always be objective, express empathy, and abide by the principle of “Do no harm.”

Here are ways that you can do this.

  1. Keep what is said confidential, unless help from other people is necessary.

It takes courage for a person to open up about their struggles. Some people refuse to share what they are going through for fear of exposing themselves to the wrong people. Reaching out to you means that they trust you to keep what they have said only to yourself. Before going through ALGEE, it is best to set up a time and a place to talk to your friend privately. This will give your friend a chance to be vulnerable in a safe space. However, keep in mind that if there is a high risk that your friend would commit suicide, ensuring their safety by asking for help from other people and authorities is necessary.

  1. Do not force your friend to share their problems with you.

Sometimes, people are just not ready to talk about their problems. If your friend outright tells you that they do not want to talk, do not force them to. Instead, encourage them to talk to someone that they trust or assure them that you are available to listen to them whenever they are ready. You can also simply ask them what they need at the moment. Show them that there is someone who is willing to listen and help, and they have the option to choose who or when they seek help.

  1. Refrain from invalidating them or trivializing what your friend is going through.

Some people keep their worries to themselves because they believe that no one would hear them out or make the effort to understand them. When your friend opens up to you, listen well and try to see the situation from their perspective. If there are things they said that you do not agree with, do not reject or dismiss what they are feeling or thinking about. If you think that their problems are too simple, remember that every person is affected by situations differently. What may be easy for you may be too much for them. Likewise, if you have experienced a similar problem and have resolved it successfully, take note that what may have worked for you may not work for them. Thus, when providing help and support, consider their strengths and weaknesses.

  1. Give your friend the control that they need through options.

One of the reasons why people usually feel distressed is because they feel that they cannot control their situation. Thus, if solutions are imposed on them, the feeling of having a lack of control will increase. If you have a solution in mind, ask first if they are open to hear advice. If they are, assure them that your advice is simply a suggestion and is open to modifications until they find one that they are comfortable with.

  1. Improvise, adapt, and overcome.

There are times when it can’t be helped to expect something from your friend or from the situation. However, it is important to be open to the possibility that things may not go your way. Something may keep your friend from getting help despite your agreement or keep the situation from improving as you both hope. Identify the challenges, seek alternatives, and try again. And remember, it’s okay to make mistakes!

  1. Watch out and prepare yourself for compassion fatigue.

While being there for a friend during their toughest times is admirable, there are times when their problems, emotions, and negative thoughts can get to you too. When you feel overwhelmed with helping your friend or are starting to feel affected by what they’re going through, you may be experiencing compassion fatigue. It is important to be mindful of the symptoms of compassion fatigue and to prepare yourself to prevent it or address it when it comes. Remember to take a break if you have to and to take care of yourself first every once in a while. It’s also important to not be too hard on yourself if things don’t go as well as you hope. If your friend deserves compassion, then don’t you deserve some as well? You can practice some self-compassion exercises to help you combat compassion fatigue.

Using ALGEE is a great way to create a mental checklist of what you can do to help out a friend during a mental crisis. However, this does not mean that you have to strictly abide by it or be overly concerned if you skip a step. The most important thing about helping a friend is being there for them and showing them that you care.

References:

Altta Wellbeing. (2019, September 30). ALGEE – 5 letters, 1 life saved every time. https://wellbeing.altta.co.uk/algee/

Jorm, A. (2016). Key Elements of Mental Health First Aid. Alan J Fisher Centre for Public Mental Health. http://cpmh.org.za/wmhd/wp-content/uploads/2016/08/Key-Elements.pdf

Martinelli, K. (2023, February 20). How to Support a Friend With Mental Health Challenges. Child Mind Institute. https://childmind.org/article/support-friend-with-mental-health-challenges/

Mental Health Foundation. (n.d.). How to support someone with a mental health problem. https://www.mentalhealth.org.uk/explore-mental-health/articles/how-support-someone-mental-health-problem

Thurrott, S. (2021, June 11). Watch for These Key Warning Signs of Compassion Fatigue. Banner Health. https://www.bannerhealth.com/healthcareblog/teach-me/watch-for-these-key-warning-signs-of-compassion-fatigue

Categories
Blog Everyday Thriving General

The Fawn Response: How Pleasing and Appeasing Patterns Impact Women’s Wellbeing

fawn response

“Perhaps the biggest tragedy of our lives is that freedom is possible. 

Yet each day we listen to inner voices that keep our life small.”

Tara Brach

As we faced frightening and stressful times during the pandemic many of us became familiar with the vocabulary of fight, flight, and freeze responses to stress and trauma. When a threatening situation arises, our nervous system sets off an automatic response toward safety and protection. This process happens unconsciously, without us having to think or be intentional about it, with the goal of survival being the immediate priority. The brain prepares the body to deal with the threat in different ways: to engage with it aggressively (fight), to run away or avoid it (flight), or to shut-down and numb the pain if the danger is deemed to be insurmountable (freeze).  In our modern world, these stress reactions are mostly triggered by emotional or social threats such as our fear of failure, loss of control, rejection, abandonment, and feelings of worthlessness. Although useful and necessary for coping with real danger, being chronically caught in the habit of these defensive responses severely compromises our physical and mental health. 

The fawn response is a lesser known stress and trauma response mechanism that deserves much more attention than it gets. Natureza Gabriel Kram, in his book Restorative Practices of Wellbeing (2021), describes the fawn response as a survival structure that utilizes our capacity for connection to disarm a threat. It usually emerges in contexts where the source of danger is someone we are intimately connected with. In these circumstances fighting, fleeing, or freezing would not have achieved our adaptive goals either because the threatening figure is someone we depend on for our survival or that using a more overt defensive response would have worsened the potential harm. A lot of times the fawn response gets reinforced early in life as a way of coping with emotionally unavailable, critical, or abusive caregiving. In the absence of supportive and empowering connections, young children may become hyper-focused on pleasing parents and caregivers by being sensitive to their distress and taking care of their emotional needs. 

Dr. Arielle Schwartz characterizes the fawn response as a pattern of pleasing and appeasing behaviors aimed at taking care of the needs of the aggressor in order to diffuse danger. It’s a rather sophisticated process that taps into the social engagement system, manifesting in different forms of accommodation that serve to befriend an aggressor in order to ensure one’s safety. In a broader sense, we could be dealing not only with physical aggression but as is often the case, our safety could be undermined by emotional threats—being harshly criticized or put down, shamed, rejected, and dismissed.  The fawn response gets activated to manage these threats. Fawning behaviors commonly manifest as being overly agreeable or helpful; never being able to say no; constantly prioritizing the needs and happiness of the other over one’s own; and forfeiting one’s boundaries, rights, and needs to avoid being attacked or shamed. Perhaps not surprisingly, the fawn response has been observed to be more common in women than in men. Evolutionarily, women have had to defend themselves against male aggressors. However, fighting, escaping, or shutting down might not have been viable responses because they had children to protect and care for. Therefore, it became a matter of necessity for women to engage in a survival strategy that disarms aggressive and controlling male figures by turning toward them and by being over-accommodating  to their needs.    

As we can see, the fawn response can become a very deeply embedded behavioral pattern which patriarchal societies have culturally entrained.

Pleasing and appeasing behaviors have become implicit expectations in females, preserving the status quo of inequitably distributed power and resources that favor men. The perpetuation of fawning patterns has immense ramifications on women’s lives. Being brought up in families and communities where females are rewarded for fawning has kept our lives smaller than the horizon of opportunities that we deserve. 

Psychologically, the consequence of fawning is that it leads us to abandon ourselves. We lose clarity about who we are and disconnect from our truth. Although fawning behaviors may appear functional and even socially desirable from the outside, on the inside what is really going on is a persistent bypassing of our internal signals.  While we can project an image of adapting well to external demands, our nervous system is actually in a vulnerable state of threat because we don’t feel safe to be our authentic self. Beneath the surface, we are constantly experiencing stress from the invalidation of our true needs and desires. Women’s physical and mental health are believed to be negatively impacted by the habituation of the fawn response. World-renowned physician and trauma expert Dr. Gabor Maté in his book The Myth of Normal (2022) makes the case that women’s acculturation into society to automatically and compulsively prioritize the emotional needs of others while ignoring one’s own is associated with the very high prevalence of autoimmune diseases and non-smoking related cancers among women. It could also help explain why women make up a vast majority of chronic migraine sufferers (Migraine Research Foundation) and take twice as much antidepressants and anxiety pills compared to men.   This is not to say that fawning behaviors are biologically determined, but that a patriarchal society thrusts this predicament upon women. 

Women’s pathways to wellness need to consider the role that fawn response patterns play in keeping us entrenched in toxic stress cycles. People around us, most of the time those who are close to us, have been accustomed to our dutiful yeses, complying so as not to disrupt the comfort of old ways. Continuing the fight for women’s liberation means challenging ourselves to pull away the curtain that keeps our needs out of sight and daring to listen to our real self.  What would happen if we stepped boldly into directing more care and attention to ourselves, to giving voice to our truth, and to saying no to the inequities we experience at home and at work? Where would these acts of self-love take us?  Quite simply, they would bring us home. 

Unlearning our fawn response is a journey into embracing the freedom that comes from self-authenticity and in recognizing the one treasure that we really are. We are in different circumstances and indeed some women struggle with more severe threats to their safety. Acknowledging  the ways we get hooked into fawning is not about self-blame but a compassionate awakening. We can practice and take everyday steps to turn our caring gaze toward ourselves, gradually exploring the new territory of taking action on our behalf and being immensely proud of the courage we’ve found.      

Practices in Unlearning our Fawn Response

1. Connecting with our Safety Anchors

Psychotherapist and author Deb Dana espouses a nervous system approach to resilience and wellbeing that emphasizes anchoring on safety. Genuine safety means honoring our internal signals to tell us when are feeling safe or unsafe about different situations. To strengthen our safety ancbors, we are invited to notice WHO, WHAT, WHERE, and WHEN we feel safe. Who are the people who make us feel safe? In which relationships do we feel heard and validated? What activities bring us a sense of safety and calm when we’re feeling overwhelmed? Which physical spaces support our feelings of safety and ease? What moments allow us to listen deeply to ourselves?  

2. Self-Compassion

Unlike self-criticism which asks if you’re good enough, self-compassion asks what’s good for you? This is according to Dr. Kristin Neff, pioneer researcher on self-compassion. The practice of self-compassion calls for the integration of tenderness and fierceness. We practice the tender side of self-compassion by being with ourselves in an accepting way, comforting and reassuring ourselves, being present to our moments of difficulty without self-judgment. On the other hand, we exercise the fierce side of self-compassion by standing up to protect ourselves, to provide ourselves what we need, and motivate ourselves toward committed action. Sometimes it means saying no, drawing boundaries, and fighting injustice.  Speaking our truth can be a form of fierce self-compassion. Dr. Arielle Schwartz suggests exploring incomplete conversations or unfinished business by journaling about the following prompts:

  • When you hurt me I felt . . .
  • The worst thing that you said or did was . . .
  • What I was most afraid of was . . .
  • What I wish I had said to you then, but never told you was . . .
  • What you could never take from me is . . .
  • I know that I am strong because . . .
  • What I want you to know about me now is . . .

3. Boundary Clarity/Observing Limits

Natureza Gabriel Kram explains that “developing boundary clarity is about learning to tune into and experience, at a visceral level, the direct energy of the defensive responses.” Because fawning overrides the fight response, which is at times necessary for self-protection, practicing boundary clarity helps us reconnect with the limits that we’ve surrendered to accommodate others. One way to do this is to allow ourselves to experience and validate anger. Instead of automatically inhibiting anger, allow it, feel the biological energy of anger in the body, and invite it to take the form of an action toward assertive self-advocacy. It could mean expressing what we don’t feel good about, making a direct request to address our need, and perhaps sometimes pulling away from relationships that curtail our authenticity. 

4. Allyship

We can draw strength and courage to end toxic stress cycles through the power of allyship. When we become aware of the cultural forces that shape the fawn response in females, it awakens us to the need for standing up together. Allyship means standing up for ourselves, for our mothers, our daughters, nieces, friends, co-workers and fully embracing our value. Allyship can be practiced in everyday life by assertively responding to micro-aggressions experienced by women. A Harvard Business Review article (2022) notes that most commonly, these micro-aggressions involve invalidation of competence, invalidation of physical presence, and diminishing or denying gender bias when it is brought up. It is important that we educate ourselves on what to look for, to speak up, and reach out to one another. 

About the Author:

Dr. Joanna Herrera is a licensed psychologist in the Philippines and in California. She obtained Master’s and Doctoral degrees in Clinical Psychology from The Wright Institute in Berkeley, California and completed predoctoral and fellowship training at the UCSF-Benioff Children’s Hospital Oakland. She has been a clinical supervisor for MA/PhD clinicians, developed mental health programs, and became the director of a community mental health program in the San Francisco-Bay Area.  She currently holds practice as a clinical psychologist, provides services and consultation to organizations, and is involved in the training and supervision of mental health professionals in the Philippines. Dr. Herrera is President and Co-Founder of We Thrive Consultancy and Wellbeing Services, Inc. and the Executive Director and Co-Founder of Circle of Hope, a non-profit organization.  She started formal mindfulness training in 2008 and is a mindfulness practitioner. She is intensively trained in DBT (Dialectical Behavior Therapy), trauma-informed treatment, early childhood mental health, clinical supervision, and mindfulness-based clinical interventions among others.