Tuesday, November 26, 2013


In aftermath of crises, initial intense connections and support networks predictably evaporate, leaving a dearth of contact for patients, clients, and the bereaved. This transition, painful and necessary, is a challenging passage even when facilitated by informed knowledge.

Within intense crisis-oriented connections, informal and formal conversations are usually one-sided, resulting in patients, clients, and people in grief feeling special and well-cared for. These temporary relationships are crucial, yet limited. Abrupt closures can leave people feeling adrift, confused, isolated, abandoned, bereft. 

During crises, a variety of professionals offer kindness, thank goodness, and expertise, thank goodness. During crises, people, fortunately, get attached to caregivers, facilitating necessary connections of leaning-against, temporary-dependency, and necessary complete trust within a wide variety of treatment interventions and specific processes. Yet when intense contacts end, people 
enter a disoriented grieving process: "I should be happy, but I am so very sad." "I am deeply grateful for all the support, but now I am alone and lonely."

Informal caregivers, tired and needing respite from absolutely essential constant and concentrated attentiveness, often disappear into valiantly-earned and well-deserved breaks. These relationships can easily be re-initiated and reformed.

Vulnerable people comforted within professional relationships are protected during and afterward by fiduciary codes of ethics, offering confidentiality and strictly-defined boundaries of OK/ not-OK professional behaviors. Formal professional caregivers' ethical codes, aware of our tendency for attachment within intense, yet intentionally-temporary relationships, insist on a specifically-defined hiatus between ending professional interactions and entering into personal friendships. Ethical codes define and proscribe dual/multiple relationships between clinicians and clients/former clients (see citation sources below). Antioch University Seattle requires 5 years before instructor/student status can be renegotiated to a clinician/client relationship. The American Counseling Association's ethical code requires 5 years prior to a romantic relationship with a former client. The American Psychological Association requires a mere 2 years before clinician/client relationship can be renegotiated to romance. 

Historically and recently, I have been on both sides of these intense relationships. Currently, I am highly aware of emotional and logistical reverberations. I am astonished by and appreciative of the team of talented radiation technicians' ability to warmly and playfully interact with me so that I experienced being personally welcomed and attended. The team members are able to closely attune, open their hearts, deal with closure of each patient's intense/daily treatment, and then offer equally-receptive attention to the next patient. Truly a remarkable skill and feat. 

After cessation of 16 days of radiation treatment, I poignantly and intensively missed each radiation team member as well as missed my escorting pals. Daily contact first thing each morning had become comforting and ritualized. As treatment came to a blessed end, so did contact with all my morning caregivers. My family and pals are certainly just a moment away, yet different from automatic daily contact. I now have to return to intentional and spontaneous social contact. Transition from intense relationships to low-key interactions requires awareness and assuring self-talk: "I am OK. I can grieve and be grateful. I am glad to return to normal life agin. I thoroughly appreciating people who deeply invested in accompanying me through that brief phase of treatment. I am OK." 
Thanks, and I miss you.

Antioch University Seattle, School of Applied Psychology, Counseling, and Family Therapy

Ann Beth Blake
(c) November 25, 2013

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