Helping a friend

The conversation should be initiated by the person with the traumatic experience. Let them take the lead with what they feel comfortable sharing. You should know that if they want to talk to you, it shows trust, and they are taking a risk. Sharing a traumatic event can be challenging and the fact that the person is speaking to you shows something about your relationship with them.

Generally, it is important to keep the difference between sharing and spilling in mind. If the person in front of you seems to spill out information, incoherently and without much active thinking it will not help them process the event. Ultimately, the outcome of a conversation should be to help them process it. This is more likely to be achieved through the process of sharing and having an interactive conversation.

A key point to understand is that there are many different responses to trauma which vary from person to person. Therefore, personal preconceptions about the consequences of trauma should be abandoned. Instead, there should be a focus on the individual experience of the person in front of you by showing compassion and curiosity and asking for example: ‘what effect did it have on you?, what was that like?, how did that leave you?. Especially at the beginning of the conversation, ask open questions such as ‘how did that make you feel?’ as opposed to ‘I guess that made you feel scared.’ In this context, the word ‘should’ is not ideal as it implies that the person is supposed to feel a certain way. This might create more pressure and add a layer of expectations. Nonetheless, as the conversation goes on, the questions can become more specific.

As to the physical environment, a place where you can walk alongside each other such as a park is better than sitting face-to-face. This will allow to place physical boundaries on the discussed topic. Otherwise, it could be in a quiet and confidential space, ideally out of individual homes. Here, it is good to know that the long-term eye-contact that is created when sitting face-to-face can establish unwanted tension.

Part of helping the person with the traumatic experience is knowing the limits of your ability to help. There are warning signs that you can look out for, which indicate that they might need professional help. The immediate warning signs are most likely to be very different from the long-term ones. This is because coping mechanisms change and evolve through time. There are no universal warning signs as they vary according to the point in time after the event, and their individual differences in developing coping mechanisms.

A coping mechanism is essentially any behaviour they engage in which enables them to distract themselves from thinking negative thoughts. Of those, some can be constructive, others destructive. In this context, the destructive ones such as excessive drinking or excessive sports are the ones to be looked out for. After a traumatic event, the immediate reaction is generally very different from the long-term reaction. Knowing whether someone will develop Post Traumatic Stress Disorder (PTSD). There should be a phase of ‘watchful waiting’ lasting between 4-6 weeks, where the long-lasting effects of the trauma will start to become clearer.

However, some aspects of the person’s daily life can portray warning signs that they need professional help, no matter the point in time. This can consist of observing their changes in behaviour and the coping mechanisms that they are developing. A traumatic experience is most likely to be life altering. The difference that should be looked out for is between life threatening and life altering.

Negative change will be reflected in behaviour in some way. These changes in behaviour can be caused by emotional flattening. This is a warning sign by which individuals lose the capacity to enjoy things. For example, this can be shown through a decrease in appetite. Questions you can ask yourself are: are they enjoying their food? Are they eating too much, too little? Are they just eating what they need to? How does that differ from their typical behaviour? Did they stop engaging in activities and interests they enjoy? This can be applied to their sleep, the use of drugs, the internet, or drinking. These consequences are likely to show in their physical appearance, for instance if they lose wight, gain weight, or their overall personal hygiene decreases. When those coping mechanisms are significantly impairing their ability to carry out daily tasks, getting professional help is advised.

You could try to address this by saying ‘I noticed I haven’t seen you in that place recently?’. Be thoughtful about how you introduce it, don’t challenge it. In their response, look out for self-blaming words, whether they are laughing it off. Humour is an intellectual coping mechanism. On top of that, look at their posture, their tone of voice, our mind is attuned to reading small changes in those aspects.

Listen to your intuition and the ‘little voice’ that tells you something is different about the person. You might not consciously know why you have that thought. However, in this case, the ‘little voice’ is worth listening to, as our minds are attuned to detecting those subtle changes in tone of voice and posture. For example, when answering the phone, you almost instantly know how they someone feeling. Actively pay attention to that when you call them. We naturally are very skilled at picking up cues on others’ state of mind or mood.

However, if someone is expressing suicidal thoughts and you believe that you are in a situation that is out of your control, you should call the police (999 in the UK). Even if they say is in a humorous way, those statements should not be taken lightly. We now know that everybody has different coping mechanisms, some people put up a front and pretend they dint have a problem and others will have humorous responses. To assess the seriousness of the situation, you can ask them whether they have any concrete plans. If they do, or you think they do that is a serious warning sign where professional help is needed. You can also call Samaritans, they do not give direct advice but they can help directing you towards the right person to contact.

A trigger is a stimulus that brings up unwanted thoughts, behaviours and often images that the person experiencing cannot control. Understand that the vast majority of triggers are internalised and abstract. Most people are not aware of their triggers, they might happen at night, in dreams or nightmares.

In case you find yourself in a situation where someone has been triggered and is experiencing flashbacks for instance, an approach you can take is based on a strategy called trigger discrimination strategy. This consists of learning to pay attention to the aspects in the moment that are different to the situation that the person is taken back to, as opposed to those that are the same. As a friend, you can help them direct their thoughts towards those differences by helping them to focus on aspects that are related to the present moment and that they can detect with their senses such as smells, tastes, the temperature, the time of the day/night. In the gentlest way possible, invite them to think about what is different, not what is the same.

Understand that the incident itself may have impacted the way the person is recalling it. This is because one coping mechanism is that the brain forgets details of the event over time periods that can vary from days to years. Thus, if you notice that something in the telling of the person in front of you doesn’t add up, don’t insist on it, let it go. Otherwise, it might lead them to doubt themselves.

Helping someone to understand that they need help is going to be difficult. The person is probably thinking that they are protecting themselves by not facing it. Convincing them through facts is probably the least effective thing you can do. Pressuring them will only add a layer of stress. Instead, you should stand alongside them and show patience. For the therapy to have the best chances of being effective, they have to want to go.

A possibly more efficient approach is to invite them to think in a range of possible options, with alternate possible futures. Initiate them to think about a future where they do or do not get professional help. This can be done through question such as: ‘What do you think will happen is you do go?, What would be difficult about going?, What will happen if you do go? What will happen if you don’t go?’

You could start the conversation with ‘this comes from a place of care, but I do wonder if we can talk about..’. One where they get help and even though it will probably not be easy, they have a true chance of getting better. This alongside the alternative of them potentially not being able to deal with it themselves and their wellbeing decreasing.

Sometimes, you should accept that it might not be a good moment for them to start therapy. In those cases, you can make plans for a moment in the future, where it might be more appropriate. For example, this could be a time period where they have a weekly structure, such as classes or a job, and their life is not too disrupted, as it can typically be in the summer for a university student.

We have to understand that it takes time to heal. Often times, steps in the right direction can be followed by steps backwards; the process is not gradual.

All in all, you have got to make sure that you keep yourself safe, as a certain weight comes with supporting a friend who has been through a traumatic experience. Therefore, it is sometimes good to take a step back and consider whether what you are doing is becoming too much. Keep yourself and your wellbeing safe as you are not supported by the professional boundaries that a therapist has.