Behind the Mask – What is a first supporter?

Letter from the Editor…

By Mike Sehl, Toronto Fire Fighter, Station 143-A

You’re a “First Supporter”

What is a first supporter?

We know we have a vital lifesaving role as first responders, but do we realize how vital we also are as first supporters? At any moment, at home, in the fire hall, or at an emergency scene, we may find ourselves offering support and assistance. Whether you are in the role of “professional responder” or simply the person who happens to be there when someone is in need, we’re all “first supporters.”

No doubt you know what to do when you arrive on scene of a motor vehicle collision or a house fire, but do you feel as confident about what to say and do when you find yourself beside someone in need of emotional and psychological support? What are some tools in our toolbox, as we are undoubtedly supporting each other, our families, and the public during this challenging time?

To answer this question, I looked to our Peer Support Team training for some guiding principles. Excellent tools are Motivational Interviewing (MI for short) and how to effectively respond to “invitations” and build a supportive connection with another.

Motivational Interviewing:

Motivational Interviewing is essentially a way of building a relationship with the person you are supporting, so that they want to work with you to drive themselves forward in a positive direction. Don’t let the word “interviewing” mislead you – it’s not about searching for answers and information, but more about opening dialogue. It is a “collaborative, person-centred and goal-oriented counselling method that aims to strengthen the client’s motivation toward healthy behaviour change” (Miller and Rollnick). It is proven to be effective with most people, in a variety of situations, and can be especially helpful for individuals who are dealing with multiple challenges and/or who are ambivalent about change. Some of the guiding principles of MI, or the “MI spirit” as they call it, are:

1. Partnership - collaboration instead of confrontation 2. Acceptance - autonomy over authority 3. Compassion - understanding vs. prescribing 4. Evocation - evocation rather than education

Through the “MI Spirit”, you are focusing on the person you are supporting, first and foremost. The individual must feel listened to, understood, accepted, and respected for who they are and where they are. In this way, they can feel empowered, and understand that they are integral to guiding their own change and recovery. This helps clients feel more like a person than a client being served out of obligation. It helps them to actually follow up and follow through on treatments and goals, because they have ownership over the plan and feel supported rather than directed.

So, how can you use this knowledge of MI? Here are three specific guidelines you can use in making connections with those around you who could use some “first support.”

1. Explore Invitations

Invitations are gestures looking for support. They can be actions, expressed thoughts, feelings, or physical cues. People use invitations when they are seeking support; the invitations are often subtle, as people are reluctant to appear vulnerable or ‘needy’. The first thing you must do with invitations is notice them. The second thing is to respond with empathy.

Actions Feelings

Loss of interest in hobbies Desperate Abuse of alcohol, drugs Angry Reckless behaviour Lonely Impulsivity Sad

Withdrawal Hopeless Physical Thoughts

Sleep disruption

“No one can help me” Changes in appetite “I wish I weren’t here” Physical health decline “I feel like a burden” Lack of self-care, grooming “I can’t take any more” Changes in interest in sex “I can’t do anything right”

Examples of Invitations:

Resources Personally, when someone gives me an invitation, I like to respond with the words, “It sounds like…”. “It sounds like you’re pretty angry about what happened.” “It sounds like you’re not getting much sleep.” “It sounds like that was a challenging experience.” “It sounds like you have a lot on your mind.” “It sounds like that’s lost a bit of its excitement for you”, etc. What’s perhaps the most important aspect about invitations, is the increased ability to recognize them once you’ve put them on your radar and listen for them.

2. Use OARS

OARS represents a way to guide conversation in response to an invitation. OARS stands for: • Open ended questions • Affirmations • Reflective listening • Summarizing

OARS guides us with tools we can use to explore invitations and ensure we are actively listening, engaging, and evoking

3. Avoid the Righting Reflex

The righting reflex is that strong urge to tell people the solution to their problem because we feel we know what would work. It’s that urge to tell them exactly what to do or think to make them “right” and to fix them. Here’s the thing – most of us know when something we’re doing may be harmful, and what we need to do to make a situation better. But just because we know, doesn’t mean we’re ready or able to do what’s needed. Having somebody else tell us what to do usually doesn’t help at all. Nobody likes being told what to do. Many studies show that even when someone is correctly diagnosed and prescribed the right medications by a professional, if that client felt diminished or didn’t feel heard, supported, or listened to, they wouldn’t participate in the “prescribed” action plan. They would not take the medications, they wouldn’t show up to appointments, etc. What does this mean for you as a “first supporter”? It means to remember that, what does help far more than pointing out the solution, is when you take the time and energy to create a supportive relationship and an environment of trust, support, and value towards that person you’re supporting.

Resist the righting reflex

“I know what is best” • Removes autonomy from the patient by insinuating the patient does not know what is best for themselves • Re-establishes hierarchy • Can undermine the patient’s motivation for change • Can creat conflict

We have to avoid... “Roadblocks”/Righting reflex

• Ordering, or commanding • Warning, or threatening • Giving advice • Telling people what to do • Shaming, ridiculing • Judging

Summary

We are all likely at some point to be that person/”first supporter”who is in the right place at the right time for someone in need. Whether it be at home, at work, in pretty much all aspects of our lives we are surrounded by people, many of whom could use a supportive listening ear, especially one willing to actively listen without judgment. In life, we will encounter situations where we will both provide and need support. So, here’s to being there for one another in our daily contact and interactions. Like Red Green used to say, “We’re all in this together.”