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In Part I, we talked about Acute Financial Stress (AFS) and why it’s been so difficult for clinicians to identify a condition that afflicts 23% of Americans (and 36% of millennials, by the way). That’s 73 and 27 million people, respectively. Staggering numbers.

We also discussed how a lack of research, a muddled diagnosis, and personal challenges on the part of therapists and clients may keep us from recognizing and discussing the most pressing issues in a client’s life.

That’s the dilemma we currently face. Today we’re talking about the reasons why we need a shared language to assess and confront AFS. Through this we can better help our clients discuss and treat this debilitating issue.

We Need a New Language

Beyond the systemic (therapists don’t learn about financial stress, it’s not an official diagnosis, etc.) and emotional issues (client’s don’t like talking about it, neither do we) blocking this discussion in therapy, we also lack a practical way to address AFS. We need to start talking more openly about finances in therapy, but we can’t start if we don’t speak the same language.

So how do we start a conversation about AFS?

I suggest we start from the very beginning of therapy — the intake session where we assess our client’s symptoms and formulate treatment goals. All therapy intakes take on a particular form, and I don’t intend to tell you to rearrange your whole system, but I do encourage you to add a few steps.

Step 1: Normalize

As I covered in Part I, financial stress can be accompanied by a level of shame that exceeds even sexual dysfunction. Finances are personal and private, and problems can grow in isolation.

The shame mantra — “If you knew the real me, you wouldn’t like me.” — has a perfect analogue where financial shame is concerned — “If you knew my income, my debt, my bad decisions, my cover-ups, you definitely wouldn’t like me.” Many of our clients feel this level of distress about their finances, and it’s our job to help them feel safe talking about these painful issues in their life.

To counter the shame, start by making it okay to talk about financial difficulties. Leading off with a brief statement of the prevalence of AFS and perhaps a bit of self-disclosure can go a long way to ease a client’s discomfort and help them open up. Again, I’m not trying to give an iron-clad script, just a starting place for you to start on your own phraseology.

You might try something like:

“We all feel a degree of financial stress at one time or another, I certainly have myself. Research has shown that nearly 1 in 4 adults feels this stress at a level that is on par with PTSD, but people don’t like to talk about it and end up suffering silently.”

Step 2: Inquire

After setting the stage, gently ask about some of the symptoms people with AFS tend to experience and follow-up questions to see the severity of their symptoms. Focus on how they manifest in their behaviors, thoughts, emotions and relationships.

Behaviors — “Have you noticed yourself checking your bank account excessively, avoiding phone calls or emails from lenders, or getting easily startled when the topic of money comes up?”

Thoughts — “Do you find yourself thinking about money or debt so much that it interrupts sleep, work or relationships? Do you ever have intrusive negative thoughts about money?”

Emotions — “Do you have strong feelings of hopelessness or worry about money to the degree that it gives you a bad day or week? Do you find yourself angry with yourself or financial institutions for the circumstances you’re in?”

Relationships — “How have your relationships been impacted by finances? Do you find yourself avoiding social situations where money is necessary, or withdrawing when the topic of money is mentioned? Do you often find yourself arguing about money?”

Step 3: Plan

If your client does disclose a high level of financial stress, you’ll want to assure them that they aren’t alone and there is help. While we’ve only recently identified AFS as a condition, the symptoms are similar enough to PTSD and other chronic stress that we have established treatment protocols.

The approach you take toward treating AFS will vary according to your theoretical orientation and training in technique. But it will likely be comprised of relaxation, identifying the internal reactions to stress and making a plan to address the external sources — the actual debt and financial institutions.

More on that in a minute, but first let’s talk general language to reassure clients about the treatment of AFS.

“It looks like financial stress is having a harmful impact on your life. Like I said, this is a common problem, so you’re not alone. Fortunately, there are several things we can do to help you relax your system, so you don’t have such a strong reaction, we can challenge some of the messages you’re telling yourself about how you handle money, and I can point you to resources to help you gain more financial stability.”

So there you have it, language to help you assess and begin a plan to treat Acute Financial Stress. Now that you have the language, take a look at what resources and limitations you bring to the table as a therapist treating AFS.

Financial Language for You

As I said in Part I, I don’t particularly like talking about my own finances because it brings up my own pain and shame. And like most every human, I resist pain, which may cause me to neglect a significant problem in my client’s life. If we’re going to walk with our clients through their struggles, including the financial issues, we’ll have to face our own struggles and limitations.

But what are our potential limitations?

Our Own Financial Stress

A client says they’re quitting, and we freak out. Our rent is raised, and we freak out. Our spouse cuts back hours, and we freak out. We’re just as susceptible to financial stress as anyone, perhaps more so, since we rack up years of student loan debt for a profession with a variable paycheck.

Spend some time in your own therapy or consultation discussing your personal experience with financial stress, so you can distinguish your baggage from your client’s baggage. And if you personally overcome your stress, you may be better able to help others.

Our Lack of Financial Knowledge

Look, I spent college in the psych building while all the finance/economics/accounting people spent their time inside a magical think tank of financial mystery, for all I know. As a result, I can barely tell the difference between a 401(k) and a 501(c)3. My brain just doesn’t work that way. With 23% of the nation experiencing AFS, it behooves me to learn more about that system. Take a look here and here for a quick education in the basics.

It’s important to know my limitations, including when to refer to a professional. I have my lists of psychiatrists, lawyers and couples therapists to whom I refer. Why not include a financial planner and an accountant? Shouldn’t therapists have referrals to trustworthy finance people in our little black book?

Money is a language many of us don’t speak fluently, and we can use all the responsible help we can get.

Our Nemesis

This is my call out on the largest level — some banks, lenders and payday loan companies are working against us. If a bully were terrorizing one-fourth of the students in an elementary school, parents would rally to contain the bully and protect their kids, no question.

Well, with their deceptive fine print, ridiculous interest rates and unscrupulous collections policies, lending companies are brutalizing a significant portion of our society. As therapists, we sign on to battle both individual and societal pathology, and many financial institutions deserve our wrath.

How can you do your part to combat corporate greed while protecting the clients you serve? A petition? An awareness initiative? Public education? There are no easy answers here, but keep in mind the perpetrators inflicting stress on your clientele.

Old Problem, New Awareness, Same Skills

Acute Financial Stress is an old problem we’re just beginning to understand. Now that we know what to look for and how to talk about it, it’s up to us therapists to give it the attention it deserves. Fortunately, we don’t have to reinvent the wheel to do so. We’re applying the same direct, compassionate language we always use to start a conversation about a topic riddled with shame and pain, on both our parts. But as the paid professional in the room, you just might have to go there first.

Next week I’ll delve into treatment strategies for AFS, including one slap-your-forehead approach with surprising results.

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Join the magical think tank of psychological coolness at my website, Facebook, and twitter feed. The real you is always welcome. 

About the Author

Ryan Howes

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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