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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Relationships: Peer Support Issues.

Q: Dear Frank, People meet people online and it is wonderful how they sometimes becomes peer support friends Someone recently wrote to me about PTSD and peer-support. Do you have an answer for this person?


Hi Joyce, I frequent the Web site and find it very helpful. Could you answer a question I have about peer support? I do find that I sometimes get stressed when I think about my trauma. The approach my therapist and I take is not to focus on the trauma unless it needs to be addressed. When I discuss the current issues related to the trauma, I tend to "shut down" emotionally and become numb. So, what to do with my online peer support friend when I need to take a break and do not want my friend to feel I am rejecting her? I have not handled this so well in the past with other friends and feel bad about that. The last thing I want to do is hurt someone who is reaching out to me. I hate this trauma stuff and wish it would go away and NEVER happen to another person. BUT, it will not go away (believe me I have tried all available options). Thank you Joyce for the services you are providing.

A: Dear Joyce, This is a very important, sincere question, from a survivor
who clearly has the compassion to help others and the wisdom to protect
herself. She asks, "So, what to do with my peer support friend when I need to take a break and do not want my friend to feel I am rejecting her?" Let me offer a few thoughts. I believe there could be an informal contract between peer support friends and even offline friends who are trauma survivors. And it includes the fact that a friend is not a therapist and is not a next-of-kin.

This online peer support friendship depends upon the ability of the one in the role of supporter to back away when the emotional burden is too heavy, and the understanding of the one in the role of support-receiver to accept that with
grace and thanks. When this works as it should both parties come out ahead.
It is a good idea to talk this over before, during and after the issue arises.
Within families, and among close friends, there often are feelings of rejection
and resentment. Even without trauma histories, close relationships are fraught
with similar challenges.

Who hasn't been short with a family member and said something in frustration
that escalated into a regrettable war of words? Or into a cold-shoulder and a
period of estrangement? Intimacy isn't easy to sustain under ideal
circumstances. The survivor with PTSD has a condition that includes a higher
probability of anxiety and hyper-vigilance, regardless of the topic of
discussion. It also includes a risk of re-experiencing a memory that one wants
to forget. And it includes the reflex reaction of numbness and avoidance--
shutting down and losing the full and normal range of emotion. Survivors with
remnants of PTSD are, in a way, like cardiac surgery patients. It is good to
gradually build up strength, endurance and resilience, but not to overdo the
exercise and damage recovering muscle. With online friends, both parties
are fully capable of understanding this. Both should pace themselves and one
another. So let your support partner know if it is a bad time for
communication, or if a particular theme is difficult to handle. You are not
rejecting your friend when you ask for a break. You are explaining your
own needs to someone who is in a good position to understand and care about
these needs.

There are many trauma survivors with a condition called "rejection sensitivity."
This is a feature of atypical depression, but occurs without depression, too.
You who read this may be very sensitive to slights from others. Or you may
have family members and friends with that condition. It usually is a feature
of personality, unchanged through time, but more or less in evidence as life
becomes more or less stressful. I am heartened to learn that the
person who wrote to Joyce, is concerned about the way another survivor
might feel if she backs away. Sometimes, however, this is a matter of
too much empathy. The one who worries about another person's sensitivity
may be very sensitive herself. And in that case, out of well-meaning concern,
the person opts out of the system entirely. It is just as likely that a
receiver of support, learning that a friend needs a break, will feel honored to
bestow that break. It is a gift. And when looked at in that light, the friend
who says, "Of course. Take care of yourself," has given a gift and therefore
has something to feel good about.

This is complicated business - helping others and receiving help from others
during recovery from traumatic and tragic episodes. Naturally, there are
feelings of responsibility and, at times, obligation. Peer support friends
and with any form of friendship, there are risks. We all have to do our best
to share and manage those risks, to be honest with ourselves about when we
are ready and able to empathize, sympathize and handle the burdens -- and
the rewards-- of contact with others who share the experience of PTSD.

I'm suggesting we be as open as possible with our peer support friends. It is always OK to back off. It is not a rejection of the person. It is a wise decision to take exposure to trauma stimuli in small, measured, tolerable doses.

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