 Asking the question, " Do you recognize distress when you see it ?" would more than likely receive a bewilderment in the face of a newly graduated counselor, and a " What kind of question is THAT?" from a seasoned therapist. "Of course I'd recognize Distress! A child could see if someone's feeling agitated, panicking or afraid ". Well now, it is quite possible that a child is more sensitive and observant than yours truly, and it is equally possible that in our firm belief we would recognize Distress anywhere, that we see right through it. Meaning, it is invisible to our eyes and senses and we miss it! There are, actually MANY ways in which we fail to recognize what is the TRUE distress our clients are experiencing. I will address only two of them. The reason being that all things psychological, physical and emotional have tributaries flowing out like branching veins in a leaf. All cannot possibly be explored to benefit. I will leave the reader to continue musing on other factors after they finish reading here. 1. DISTRESS vs SILENCE. A common notion about Distress is that is is associated with some sort of demonstration. Sobbing. Yelling, Shivering, etc., the outward evidence of inward turmoil - a SOUND of some kind. Thus, when a client sits quietly, even calmly, and is silent, it is quite possible for the therapist to assume all is well. The client is taking time to think about what has been said ( possible), is not feeling like talking at the minute. Also possible, and also possible is the therapist filling in the gap by talking . Not helpful if true mulling over things is happening. One cannot think clearly about personal events and insights with someone talking, even if it is connected to the subject. There is, for me, a silence that allows my client to absorb, process, seek understanding and so on but this is not Distress. However, there is a silence that is deep Distress. Not a sound comes forth. Not even a hint of a sigh or sob, but Distress, never-the-less. There is a real difference between Silence and Silencing. The useful Silence mentioned above is productive. Silencing is harmful and results from many things. A number of people have told me how they have been silenced by their therapists. I have silenced people too, and here are some of the ways we, as therapists, can do it Our clients: Being told they are trying to get attention, imagining things, and are having false memories. Told how they are feeling, what they are thinking, why they behave as they do all beautifully interpreted by the voice of Authority informed by our Theory of choice. Their voice is taken away by disbelief, paternalism, no time given for THEIR needs to be spoken. An impatient look, ( includes clock watching. This small act does not go unnoticed), the therapist shows discomfort and cannot sit with raw emotions so none are allowed out. Therapist changes the subject and what the client has on their mind is disregarded and flies out the window. ( This one is very common and deadly for silencing). There are many more ways we silence our clients, but the point I wish to get over is this: Distress is not only emoting in some audible fashion. A man, woman or child who sits mute, possibly with a smile on their face, can be in the deepest distress for the causes stated above. Because we are not mind readers we have no idea what a person is thinking. If we are not listening to what we are saying, REALLY saying, for example from above, we make the accusation that some story of torture or sacrifice witnessed or participated in by a cult/group survivor is most assuredly a false memory or a desire to gain attention, it will immediately close the mouth of our client from sharing anything else.They know it is going to be interpreted as fantasy or manipulative. It doesn't even have to be that severe an event. I have heard it said that time and time again people have been silenced because they have felt disbelieved about seemingly ordinary things that hold far from ordinary meaning for them. But in silencing these, significant details are dismissed. If we are not listening, REALLY listening, we can change the subject wafting off on a train of enlightened thought we had about something our client said, and anxious they hear our interpretation of it. Or we associate what they are saying with another aspect of their life and completely silence the one who desperately needs to finish sharing what they are struggling with. If we make a helpful connection like this it can always be filed in our memory and returned to another time. It can wait! When we err these ways, not only are voices silenced but we have lost important material that needs to be worked through. That they sit quietly before us while we talk can be the muteness of resignation. The futility of trying to be heard. It is the Distress of the abuse survivor who has always been silenced and never allowed to show their hurt. They have sometimes been told to smile to show their agreement with what is being told them - hence we mistake smiling as being a sign of agreement with our view of things. So how do we counteract this error ? We monitor ourselves within, taking note of what we are saying and why we are saying it, what we are doing and why we are doing it, and we ASK . We ask how it is for our client. If there is anything that is being overlooked, changed for them, if we have not heard something correctly and if so, what has been misheard and what is their meaning. We ask if they have finished what they wish to talk about and apologize for interrupting and changing the subject if we are alert enough to realize we have done so. Many, if not most, survivors who have never been allowed to voice anything will be unable to say even when asked, and if we realize this fact but have not understood the distress beneath the calm, it is up to US, to RECOGNIZE Distress and gently inquire if perhaps there is something more they would like to tell us but it somehow got cut off. Bottom line, if we distinguish between silence and silencing we will be better able to recognize the reenactment of how survivors have long ago learned how to hide their distress and present as having none. 2. DISTRESS vs. BODY LANGUAGE. I have mentioned smiling. Perhaps because of my own experience with the falseness of smiles (people smiling in pretense of welcome immediately followed by complete ignoring of my presence). Smiles on the face of an abuser while they say they love us in rhythm to the beating. Talking about Love while emotionally hurting and physically inflicting pain on another distorts Love and any belief in the speaker's words. Hypocrisy at its worst. I question smiling. So the one in the client's chair is smiling and we think all's right with the world. We do not realize or recognize the Distress of compliance based in terror. It is even possible to be inwardly congratulating ourselves on having managed to help our client feel good about themselves! Wrong! When I have observed a smile I ask the person what it means and this can lead to opening a wealth of material. Tears. We all react to weeping differently depending on what they evoke in us. The mistake we can make in thinking tears are always about Distress is in thinking they are. This is not necessarily so, but can we recognize the difference? Some tears are tears of relief. Something makes sense that has previously been a source of unvoiced terror. The "not Knowing", now becomes, " I know". Some tears can actually be joyful. A little victory won that the CLIENT recognizes and acknowledges. Instead of being told they have made changes in a certain area they SEE it for themselves and the tears flow. Some tears are tears of forgiveness and not of Distress. These tears are not connected with the fear of, and rage towards, the perpetrator of pain but the power of being able to be free of the influence and forgive the abuser. This does not mean forgetting, but the pushing them out of their previous seat of control. Thus, we might do a disservice to our clients in not being able to dsitinguish between tears of Distress and tears for other causes. How good when we can recognize the source and instead of commiserating how we empathize with their distess and have them look at us blankly, "what are you talking about?", we are able to zero in on the true meaning and talk about that. Physical vs emotional distress. When faced with a client who is suddenly writhing in their chair, a good therapist will always question if there is a physical cause for bodily discomfort. One needs to rule out this possibility (e.g. an acute attack of appendicitis), but it is amazing how commonly emotional or psychological distress is not recognized. The knowledge that there is drug use in a person's story might predispose the therapist to allot physical symptoms to drug reactions, or dwell on somatic pains rather than the underlying emotional or psychological distress that made the person turn to drugs to numb out the heart suffering, or relegate emotional and/or psychological Distress into body symptoms. (Psycho-somatic) Bowed head and shoulders, rigidity of body, clenched hands, shaking legs, downcast eyes, blatant and not so evident body gestures can also be misinterpreted as Distress, and in one sense this is accurate, but what KIND of distress? There is one Distress that abuse survivors will rarely voice - it is the deep deep feeling of Shame. This Distress will be shared only with those therapists who are aware of its entrenched hold on their client's psyche and their immoveable conviction of being guilty, the cause of all the troubles, to blame, humliated, feelings of self-loathing and self-hatred and the thought of contaminating others. If this shame Distress is not recognized it will be lost under the treating of the overlaid physical behaviors that could be , and oftentimes are, connected to the more obvious feelings of terror, grief, rage and so forth. Here, we as therapists, need to self-examine our own reactions to dealing with Shame, both personal and that of others'. If we have truly faced this emotion we will not only be more open to working through it with our clients but we will be much more likely to recognize the Distress of Shame and not miss it. Shame is a subject in its own right and I will no doubt be posting an article about it at some point. One last little thought is this - can we, as therapists, honestly discern between our client's distress and our own? My Article on Retraumatization, ( see: www.goessoftlyishere.com), speaks to the effects of not dealing with our countertransference distresses. This ability to recognize what is our "stuff" and what belongs to our client is vital to the therapeutic process. Can we truly recognize our own baggage and claim it? It is crucial if we are to truly help our survivors survive. If they, in their innermost being, ( whether or not they tell us), feel we have RECOGNIZED their Distress and have put it where it belongs, we are building on solid ground and not chasing shadows. I end with the question again, " Do we recognize Distress when we see it?" 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