Self-Care

Photo credit: Heather Paul

Photo credit: Heather Paul

What is self-care?

Goodtherapy.org defines self-care as “the actions that an individual might take in order to reach optimal physical and mental health.”

I think of it as intentional ways of nourishing and building resilience in the spirit and body; deliberate efforts to support physical, mental, and emotional health.

 Why is self-care important?  You can't pour from an empty cup.

 My answer is that when I was in grad school, one of my professors, Dr. Bernadette Torrez, made the point that we (therapists) are “the instruments of therapy.”  I understood her at the time, but as I came to practice I realized in a more profound way how my energy level, health, and mood affect sessions with my clients.  Like most therapists, I developed a certain ability to set my problems aside, and be present for my clients, but certain things, like migraines, can't be ignored.  It's on me to do my best to prevent those sorts of things from happening in the first place.  Self-care is especially significant in my field where I am helping people process, contain, and navigate heavy emotional experiences.  There is a high rate of burnout in my profession, and I don’t want to fall victim to it.  The field as a whole recognizes how important an issue this is, and places a strong emphasis on learning to prioritize and practice self-care.

A self-care plan involves:

  • Recognizing why self-care is important to you.

  • Creating a list of ideas that work for you and your lifestyle. I think that it’s good for the ideas on your list to vary in terms of ease, commitment and expense. After a hard day at work, you might not want to go on a hike, but an Epsom salt bath might be just the thing.

  • Setting aside time in your schedule to incorporate those ideas.

Some of my favorite self-care ideas, and some links to more information:

  • Spend time in nature!

  • Regulate your sleep, and when that’s not possible:

  • Take a nap – This could be a 10-15 minute “power nap,” or it could be a luxurious 2 hour nap, depending on your needs and available time.

  • Create a happiness journal. This can be an excellent resource when you are feeling over-extended. Imagine a book where every page reminds you of something positive in your life that you have a personal connection to.

  • Vary your routine. This will create a shift in energy and thoughts.

  • Bring mindfulness to ordinary activities. Maybe 15 minutes of meditation in the morning is too much of a commitment, but slowing down to savor your food, feeling your feet on the ground as you walk, rubbing your fingers together and trying to feel your own fingerprints; these are things that can be done easily and will still bring your focus into your body, and into the present.

  • Find a swing and use it! Play connects us all with our happy memories.

  • Breathe deeply and with intention. This might be the easiest way of practicing self-care.

  • Drink lots of water; our bodies need it!

  • Eat healthfully

  • Practice saying no to things you don’t want to do.

  • De-clutter. Some people function better in chaos; I am not one of them. When my space is clean and clear, I find myself being much more productive and creative.

  • Dance, stretch, move your body.

  • Unplug from social media.

  • Indulge yourself. This could be a small indulgence like a piece of chocolate, or it could be a getaway to a tropical island. It all depends on your tastes and budget.

  • Activate your self-soothing system. I do this by putting lotion on my arms, or getting a massage.

  • Create a compassionate mantra for yourself (see earlier blog post on how to do this).

  • Laugh – whether this means watching a comedy or calling your best friend, laughter is truly the best medicine.

  • Come up with a list of compliments for yourself. Don’t limit yourself by what you think. What would your favorite aunt have to say about you? Or your best friend? Or your cat?

  • Look for beauty. Try using your phone to take pictures of 3 beautiful things a day.

  • Write a heartfelt thank you note to someone who has been of help to you. Whether or not you send it, the writing will put you in touch with your feelings of gratitude.

  • Buy a set of Mixed Emotions Cards. These are one of the best tools I know of to help identify emotions, resolve conflicts, and make decisions.

  • Find an animal to play with or cuddle: unconditional love wrapped in soft fur.

  • Take time for yourself. Many of us have over-packed schedules and overwhelming responsibilities. Take a break; you deserve it.

  • Take a bath, preferably with a lot of Epsom salts.

This is my list.  What is yours? 

Addiction

At their emotional root, addictions share a lot of similarities:

Pain - in all addictions there is a core discomfort or pain, and a compulsion to do something to relieve it.  

The reasons for the pain and its severity will vary from person to person; the neurochemistry involved will vary based on both the person, and the drug or activity used; and the desired state or high, will vary as well.  

Gabor Maté's thoughts on the relationship between pain and addiction:

Trauma - it could be a root trauma that the addiction was created to escape, or the traumatic results of the addiction itself, played out internally or in the community.  Either way, the trauma needs to be addressed in order to reduce or eliminate the need for relief and escape. 

Internal Conflict - common to all addictions is a conflicted internal dialogue.  

The desire, longing, and feeling of need intrinsic to all addictions is a very right-brain experience: it operates outside of time (in the now), it's not particularly logical, it's emotionally motivated, creative, driven towards positive sensory experiences, and not particularly concerned about consequences.  

The aftermath, or comedown, is when the left-brain kicks back in: suddenly consequences reassert themselves, as do logic, history, and regret; it looks at the past and sees failure, it projects this pattern to the future and leaches away hope.  This lack of hope and space of judgment pave a deeper path on this cycle of use.

By stimulating both sides of the body, and therefore both sides of the brain, EMDR can create connection and dialogue between these two unintegrated experiences; desire is undercut by the memory of regret, emotion is tempered by logic, and the big picture, once established, is there to stay.  

EMDR as a therapy was developed for trauma, and most of the research has been directed towards that, but the anecdotal experiences of therapists who use it to treat addiction look incredibly promising.  I've had positive in my own private practice, as well.

When doing addiction work, I use Motivational Interviewing in conjunction with EMDR.  These modalities work well together because both operate on the premise that every person has a pretty good idea of what health looks like.  It might seem impossible to reach, it might change over time, it might be something only seen on TV, but there is a template or foundation of belief from which to work.  Motivational Interviewing encourages people to nourish their own ideas about health, and to explore and acknowledge any internal conflicts that might be holding them back.  It requires meeting people where they are in their process, without any shame or judgment, and exploring what’s true for them.

 I enjoy doing addiction work, in-part because I’ve been around a lot of addiction, and have seen the consequences to people and their communities.  I’m also just grateful for my ability to be that non-judgmental ear that can help people relax and feel safe to explore.

Stepping Outside of the Comfort Zone

photo credit: mami hasegawa

photo credit: mami hasegawa

"In truth, comfort zones are not really about comfort, they are about fear."- Cylon George

"We pay a heavy price for our fear of failure. It is a powerful obstacle to growth. It assures the progressive narrowing of the personality and prevents exploration and experimentation. There is no learning without some difficulty and fumbling. If you want to keep on learning, you must keep on risking failure — all your life. It’s as simple as that." – John Gardner

As an animal species like any other, bent on our own survival, we are predisposed to seek safety; hence our natural inclination towards the comfort zone.  In the comfort zone our activities tend to minimize risk and stress; we create a rut of routine behaviors, a place of stasis and neutrality.  We can predict outcomes, because change is minimal; we’ve seen it all before.  By stepping out of our comfort zones, by challenging ourselves, and attempting new things, we’re running a risk; anything could happen.  That said, taking risks is how we grow, how we stretch ourselves, and how we master new tasks.

"Did you ever do something you were really proud of when you were in autopilot mode?" - Carolyn Gregoire

 Creativity is inherently linked to novelty and experimentation.  There can be no surprise that it is also linked to happiness.  And creative people, who regularly risk failure and vulnerability, when counter-balanced with the joy of flow, also have increased opportunities to build emotional resiliency. 

As children people tend to take risks: everything is new, everything is a challenge, and our minds are designed to explore, experiment, soak up new information, and make new associations.  During this period, we develop in body and mind at an amazing rate.  At some point we start to make the connections between actions and consequences, and to project future possibilities.  We learn to inhibit our actions to avoid potential failures, and the resulting blame, shame, or pain.  In so doing, in creating these buffered comfort zones, we protect ourselves, but we restrict our growth as well.  The tendency is for these comfort zones to solidify as we grow older, limiting our experiences, and our access to the world.  If we could consciously make the decision to break down those self-imposed barriers, I believe that our lives would be more fulfilling in the end.  After all, it is the peak experiences in life that we remember and treasure.

“In becoming a person who regularly takes calculated risks, challenges yourself, and tries new things, you'll cultivate openness to experience, one of what's known in psychology as the "Big Five" personality traits. Openness to experience -- which is characterized by qualities like intellectual curiosity, imagination, emotional and fantasy interests, and a drive to explore one's inner and outer lives -- has been shown to be the best predictor of creative achievement.” -  Carolyn Gregoire

 There is a difference between failure and fault that's important to distinguish. The Oxford English Dictionary defines failure as a “lack of success in doing or achieving something,” a rather neutral definition.  In contrast, it uses the adjectives: unattractive, unsatisfactory, misguided, and dangerous to define the word fault.  In reframing the idea of failure, you lose that sense of intrinsic judgment.  In many ways we learn as much if not more from our failures than we do our successes.  The fact is that if we try new things, we are destined to eventually fail at something.  Getting comfortable with the idea seems a worthy effort.  Mistakes and failures can even be funny in the right light.  The most embarrassing moment I’ve ever had is now my favorite story; I can’t tell it without cracking up, and I take every reasonable opportunity to tell it.

 I’ve just given a bunch of reasons to step outside the comfort zone, but maybe you have some of your own to develop and contribute.  It might be worth it to take some time to think about them, and write them down… maybe put them somewhere visible for when your determination falters.  Having this list easily accessible could help you manage stress, and maintain motivation.

 The next question is how does one actually do it?  The inertia is real!

 I have a bunch of ideas I’ve gleaned from life, from conversations, and from articles I’ve read on the subject: 

 The first step might be to identify what it is that you want to do but are afraid of.  If you’re aware of the things you desire but avoid, then you will have some concrete goals to work towards.

 Then perhaps figure out what specific fear lies behind the avoidance.  Is it fear of failure, disappointment, physical harm…?

 What is the positive possibility, the answer to “what if this works?”  How would conquering this fear benefit you?  Answering these questions will on some level reframe fear into opportunity, turn nervous energy into excitement, and create a new narrative.  This might sound like an “easier said than done” moment, but it’s one of those things that would become easier with practice. (AND once this perspective is well thought out, a little EMDR would probably be very helpful in working through the fear).

 In making changes, I would take baby steps, small changes that are easy to make.  It doesn’t even matter how small as long as they are heading in the desired direction.  Whatever is doable without being too stressful would be fine.  If it’s too stressful, it becomes difficult to maintain, so it’s better to make small easy changes towards overcoming fears. Each small successful change will lead to increased comfort when attempting the next.

 When things do become uncomfortable, as they inevitably will, it might help to try to rest in the discomfort, and breathe through it.  Really, we’re talking about a kind of exposure therapy, exposure to discomfort.  Over time, with the afore-mentioned baby steps, it would become more comfortable.

 More important than the size of the step is the frequency of the efforts. Remember, in stepping outside of the comfort zone you’re trying to build a habit out of change itself, and habits are the product of repetition.

 We all have our comfort zones, (mine is alive and well).  It’s lovely to have them as a retreat, a place to rest and regroup, a place of comfort and safety.  That said, it seems like too much time spent there means denying oneself a lot of the richness life has to offer. 

Photo credit: mami hasegawa

Photo credit: mami hasegawa

Cultivating Happiness - Creativity & Flow

photo credit: dean hochman

photo credit: dean hochman

I’m currently thinking about happiness: what leads to it? Is it the goal in life? Why is it easier for some to achieve than others?  What makes a happy life? 

It turns out that money certainly isn’t the answer.  Once people have enough to get by comfortably, money doesn’t add much to happiness. 

I’m really intrigued by the idea of flow.  Flow is a state that you achieve when your challenges and your abilities are both high: when you lose yourself in your work because you are so engaged in it.

For many people this happens when in the process of creating something new; I’ve realized that for me this happens when creating art, or cooking.  This is the reason that adult coloring books are becoming so popular; it’s a kind of meditation.  You don’t have enough attention left over to focus on your problems, your body, or even your existence.  In a way, you disappear, lose yourself in the activity, or you merge with your work.  This state has been described as effortless, spontaneous, and ecstatic.

Experts who study flow have described it as a state where an intense focus leads to a sense of ecstasy and clarity; time disappears, and you forget yourself because you feel part of something larger.  You know that you can be successful at what you’re doing; you know exactly what to do from moment to moment, and you receive immediate feedback from your process.  This is effort for its own sake.  It’s a passion for doing your best and enjoying your work.

Given all of this, it might be worth a few minutes thought, no? 

What activities can you lose yourself in?  How often do you create opportunities to do so? 

Cultivating Happiness - Rituals

photo credit: Ana-Sofia Arizpe

photo credit: Ana-Sofia Arizpe

Our daily lives are filled with rituals, many that we're not even aware of.  They create a tempo, a pace, as we pass through our daily activities, and a space in time where we can breathe and turn inward.  Some might serve as an escape, and some might bring a moment of peace to savor.   Perhaps it's the first sip of coffee in the morning, or that moment when the kids have gotten out of the car, for many it might be that first drag of a cigarette (we can talk more about that later).

Recognizing your rituals, is a way to further come to know yourself.  What rituals are compulsive, what ones do you want to cultivate in your life?  Are your rituals solitary, or do they connect you with other people?  How long have you had them?  Are they part of your family culture, and passed down through generations?  Or are they creations of your circumstances, and forged in the moment?  Do you enjoy them?  When you think of them and scan your body sensations do you feel light and yearning, or heavy and dreading?

What rituals do you dread?  This is an excellent EMDR topic, by the way!  Can you think of any ways to eliminate them?  If not, then your work might be to try to eliminate the feeling of dread. 

What are some of the rituals you enjoy?  Try making a list of all of them and then increasing the time you spend doing them.  

http://time.com/4042834/neuroscience-happy-rituals/

Cultivating Happiness - Happy Place

photo credit: Brian jeffery beggerly

photo credit: Brian jeffery beggerly

A fun exercise, and one that I do with all of my clients, is to take a moment to imagine:

What does happiness look like?  Where would you be? This could be someplace you've actually visited, someplace you've seen in a photo, or someplace you've imagined.  What's important is that calling it to mind brings up feelings of tranquility or joy.  What other feelings would you experience while there?  

Would anyone be with you?  Here, it's a good idea not to include people with whom you have a difficult relationship; if anyone is there with you it should be someone about whom the overwhelming feeling is positive, from whom you feel connection, love, and support.  

What sounds would there be: birds in the trees, waves, children laughing in the distance?  

What would the weather be like: warm, or crisp? Would there be a breeze or stillness in the air?  Maybe it would be raining?  

Would there be any scents: the ocean, perhaps, or flowers, or food cooking?  

How would your body feel: relaxed, exuberant, weightless?

It sounds simplistic, but spending the time to truly develop this "happy place" in your imagination can lead to big benefits, in that it can become an imaginal "mini vacation" that you can access easily in moments of stress.  Doing this activity by itself is relaxing; doing it in conjunction with EMDR is even more so!

Suicide

photo credit: martin

photo credit: martin

Resources: 

 

 

A matter of life or death is worth a conversation.

There are myriad reasons why someone might feel suicidal (isolation, powerlessness, pain, hopelessness, brain chemistry, escape, illness...), and at the end of the day there is only one person who can make the decision.  My concern about suicide is that oftentimes people in those situations are feeling so desperate that they are unaware of their resources, or unable to access them, and because of this the situation might appear worse than it actually is.  I don't judge people for their feelings, but I do hope that they can reach out for help with their feelings, before any drastic action is taken.  My concern is that for many people it can be a permanent solution to what would otherwise have been a temporary problem, and that is just a loss for everyone; we are all more connected than we think.

Another reason for concern is that I have frequently heard from survivors that the suicidal attempt was regretted as soon as it was made:

In the words of one survivor, "I instantly realized that everything in my life that I'd thought was unfixable was totally fixable - except for having just jumped."  K. Baldwin

In the words of another, "What the hell did I just do?  I don't want to die."  K. Hines

"Dr. Seiden's study, "Where Are They Now?," published in 1978, followed up on five hundred and fifteen people who were prevented from attempting suicide at the bridge between 1937 and 1971.  After, on average, more than twenty-six years, ninety-four percent of the would-be suicides were either still alive or had died of natural causes.  "The findings confirm previous observations that suicidal behavior is crisis-oriented and acute in nature," Seiden concluded; if you can get a suicidal person through his crisis - Seiden put the high-risk period at ninety days - chances are extremely good that he won't kill himself later."  

 

Language - Mantras

Many therapies are based on the premise that our automatic thoughts, our self-referential stories have an enormous impact on our experiences of life.  This might seem obvious, but I just wanted to put it out there as a preface to talking about mantras.

We have tens of thousands of thoughts a day.  They flit through our minds so quickly that we hardly notice.  Most of these thoughts won't ever register as memories; there's no emotion or importance attached to them so they just come and go.  

We speak aloud approximately one thousand sentences per day (it's true that men speak less than women).  These thoughts are more important: we've chosen them, arranged them into sentences, and their very importance means that there is some degree of attachment or emotion tied to them, also they are now connected to the physical actions and sensations of speaking and hearing.  As you involve more senses in the creation of a memory, you're activating more areas of your brain, and building more neural connections to that memory.  The interactions of the multiple regions in our brains necessary to speak mean that these thoughts stand a better chance of becoming memories; the more connections the easier the memory retrieval.  That said, most of what we say is pretty fluffy; "hi" and "what's for dinner?" are unlikely to stick around long.

The thoughts that stick around as lasting memories are the ones that either repeat frequently, or are deeply important and therefore emotional.  There are evolutionary reasons for this, which are connected to community stability, safety, and survival.   If something is dangerous and scary, or invites the displeasure of people upon whom you are dependent, you don't want to forget and accidentally do it again.  So out of necessity, we've evolved to remember these things.

This has both negative and positive implications:  

Negative thoughts carry about three times the psychic weight as positive ones.  This is important to remember in child-rearing, or teaching, because children are especially vulnerable as they are forming their worldview, and sense of self.  A careless criticism takes a lot of repair to fix, and can have long-lasting consequences.  

The positive side of this is that we can choose to actively repeat certain thoughts, or better yet say them aloud.  We can make thoughts take up more mental real estate by repeating them, feeling them, investing in them, and we can consciously choose what we want those thoughts to be.

An interesting exercise is to take a moment to think about what you want to believe.  Keeping in mind that you can't trick your subconscious, you want your mantra to be rooted in reality.  In this exercise you want to come up with a positively phrased sentence that acknowledges the truth of the situation, but also voices the preferred thought.  Once you've created the right mantra for your situation, you then want to ritualize it to give it gravitas, and so that you'll remember to use it.  Something like "I'm nervous about riding in cars because of the car accident, but I want to be comfortable riding in cars again," said aloud every time you get into a car.  It's worth a shot at any rate; I've seen it be very useful in conjunction with therapy when working with PTSD.