Category Archives: Life Transitions

Comings and Goings…The Circle of Life

People come and go in our lives for a variety of reasons.  Sometimes it’s because we meet a new friend, or a relationship ends.  Maybe we’re the one coming and going as we change jobs or move to a new city.  At some point, our entrances and exits are more substantial…we are born and we die.  That’s the circle of life.

In the Not So Distant Past

While both birth and death are an unavoidable part of the human experience, I suggest that as a modern culture, we treat each of them very differently.  However, this hasn’t always been the case.

As a big fan of Call the Midwife, I never tire of watching the sanitized TV version of babies being born. The series takes place in an East-London neighbourhood, during the 1950’s and early 1960’s.  Among other things, it chronicles the progression from the norm of home births to hospital births; and the resulting changes in the expectations of everyone involved.  I’m not advocating one birth experience over another, just noting the shift of birth taking place at home vs. taking place in a medical setting.

Like birth, death has also moved locations. In the past, the common practice was that we died at home–circumstances allowing. Ideally, the dying person was surrounded by family and/or friends who were there to offer comfort to the individual and each other.  Family members shared the final tasks of preparing their loved-one for burial. Visitation was held in the family home. Birth and death were very personal, yet community, experiences. Now, most of us can expect to die in a hospital, and prepared for our final resting place by funeral home staff.

A Semi-Current Picture

According to Statistics Canada, in 2014 approximately 259,000 Canadians died. The Fact Sheet published about Hospice and Palliative Care in Canada reported that 70% of those deaths occurred in hospitals.

On the flip side, 2014 saw approximately 384,000 Canadian births (142,000 in Ontario). A December 2015 Toronto Star article outlined a three-year McMaster University study that noted midwives attended 10% of all births in Ontario (2014 is included in their data).  Of this 10%, 20% of these births occurred at home.

The bottom line…most of us will come and go in a hospital.  However, the picture may be changing.

Thoughts on Current Practices of Life… 

Midwifery, was regulated in Ontario in 1994, as a publicly funded service. Currently there are more than 700 registered midwives in Ontario who provide neonatal care to pregnant women, attend their deliveries and look after the mother and baby following birth.  With the 1994 law, midwives have hospital privileges (including access to hospital staff and resources). The blending of the two options gives expectant parents more choice of where to deliver their babies.  It is no longer a binary decision of at home with a midwife vs in hospital with a obstetrician (most family doctors no longer deliver babies).

According to the McMaster study, for women with low-risk pregnancies, babies delivered at home were at no greater risk than those in hospitals. We can have the best of both worlds.

…and Death

The same choice has begun around end of life decisions as well. The number of hospice centers and palliative care support is growing steadily.  According to an Ontario Ministry of Health and Long-term Care position paper:

“Ontario is working to provide patients with more choices for palliative and end-of-life care.

This includes investing in more hospice care across the province and expanding caregiver supports that help families and loved ones support palliative patients at home and in their communities. Ontario will also support more public education about advanced care planning so that patients’ wishes for end-of-life care are understood. The province is establishing clear oversight and accountability for Ontario’s palliative care services, to further advance patient-centred care.”

It will be interesting to see the effects of assisted death legislation on end-of-life location options.

Speaking of options, there are now death doula’s or midwives who spiritually help individuals and their families through the death process.  Training programs to become a death doula are now available throughout Canada and the US.  Both MacLeans magazine and Global News have covered this subject.

Death is Making an Appearance

While our culture tends to hide death–even in the language we use to describe death (“passed away” or “passed on”);  I have started to notice some changes.  Besides the increased visibility of hospice and palliative care and debates on assisted death, end-of-life has started to take up space in our current frame of reference.

At first it was something I glimpsed out of the corner of my eye.  A colleague had mentioned that he had attended a weekend workshop on “home funerals”.  The event took place in a private home, and included information about the rules and some basic skills for taking care of your deceased loved from death until burial. While not for everyone, this is a fascinating alternative to the current practice.

Next, over the six-month period, numerous articles appeared in the local paper:

  • A story about a Romanian cemetery (called the Merry Cemetery) where the crosses are etched with colourful epitaphs and drawings describing the deceased’s life and/or personality;
  • A helpful article about “tying up the loose ends of life”;
  • Another article assuring readers that “death doesn’t have be so frightening”;
  • A commentary of the Mexican tradition of the Day of the Dead–a family celebration that sees family members and friends having parties in local cemeteries as they visit their loved ones;
  • And finally, a review of the book  “The Gentle Art of Swedish Death Cleaning: How to free yourself and your family from a lifetime of clutter.”  A new reason to declutter.

I came across information about the Good Green Death Forum (an event organized by the Green Burial Society of Canada) and DeathCafe.com (a social event where people talk about death with the goal of increasing their awareness of life).

Ideas about death appear to be popping up in popular culture.

Why Does This Matter?

As a therapist, I tend to look at things through the lens of mental health.  While birth is usually a happy event (no matter where it takes place), I have concerns about how we deal with the end of life. With the movement of death from plain sight over the past decades, it has become scary.  Combined with our culture’s fixation on youth, this fear has escalated.  As with most things in life that we don’t understand, when we push them away they become something mysterious, and to be feared.

But do we have to continue to treat death this way?  Instead can we use a familiarity with death as a tool to help us live more aware and fulfilling lives?

Another Way to Look at Death

In many Buddhist traditions, a purposeful contemplation of death is one practice that is used to help individuals become aware of the constancy of change and life’s fragility.  The concept is that when we realize that nothing in life is permanent and everything is easily broken, we look at events in our lives differently.  We may appreciate to a greater level not only what we have (including health, relationships, and things), but also the people we love.  From this perspective, while we may grief loss (from the breaking of a favourite cup to the loss of something greater), we understand it to be part of a greater whole.  As well, to quote a best-selling book title, we “Don’t sweat the small stuff…and it’s all small stuff”.

Death as an Exercise

I’ve come across a few books over the years (The 7 Habits of Highly Successful People and She Means Business (to name a few) that advise readers to become comfortable with their own death as a way to add focus to their lives.

These authors lead a guided exercise in which the reader imagines, in detail, their own funeral or memorial service–paying particular attention to what their family and friends are saying about them.  These imaginary statements become nuggets to be mined as you set life goals.  I’m not sure if it works, but could be an interesting exercise.

Finally…

We can’t hide from the comings and goings in our lives…whether it’s us or someone else.  However, we can become less fearful and more mindful.

And now…somewhat predictably, but none the less still moving after all these years (movie came out in 1994)…The Lion King – Circle of Life.  Enjoy!

 

 

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The Caregiver’s Journey–Part 2

In last week’s post, we explored the specific parts of the Caregiver’s Journey–the beginning, middle and end stages–what can be expected at each stage and ways to cope.  Today, we’ll specifically look at the burnout that can be experienced by some caregivers.  What are the risk factors?  How do you know if you’re feeling burnout?  What can you do to prevent burnout?  This is the second in a three-part series on care-giving.

The information in this post is a partial summation of  information that was presented by Dr. Virginia Wesson, Psychiatrist and Dr. Rhonda Feldman, Psychologist.   Both Drs. Wesson and Feldman see patients, and their families, at The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer’s Support and Training.

A Story…

Dorothy and Marion (both aged 74) have been together for 40 years.  Ten years ago, when they retired from their careers (Marion was a teacher, Dorothy an operating room nurse) they had plans to travel.

Shortly after Marion left her job, she developed a cough that wouldn’t go away.  She lived with it, but became concerned when she started to experience a tightness in her chest and shortness of breath.

Rather than visiting the doctor, Marion decided that maybe a change of climate would be helpful, and the couple planned a trip to Arizona to visit friends.  “Perhaps the heat and rest would improve Marion’s symptoms”, Marion thought.  Unfortunately, there was no change in her health.  In fact, once out of her home environment, Marion became easily tired and was unable to join Dorothy and their friends on day trips.

When the pair returned home, Marion agreed to seek medical advice.  She was diagnosed with the Chronic Obstructive Pulmonary Disease (COPD)–a chronic inflammatory lung disease that causes obstructed airflow from the lungs.

Marion and Dorothy were shocked by the diagnosis.  Both had been smokers at various times in their lives, but had quit ten years earlier.  However, one of the causes of COPD is smoking and the habit had left its mark on Marion’s lungs.

At the beginning, after the shock wore off, the couple found ways to cope with the changes in Marion’s health and her decreased energy level.  Long-distance travel was out of the question, and with Marion’s new medication, they were able to make the most of day and weekend trips.  Because they were both retired, Dorothy found it easy to take over some of Marion’s tasks.  The women were able to cope in this first stage for a long time, adjusting as Marion’s health slowly deteriorated.

Risk Factors for Burnout

As explored in last week’s post, burnout often starts to appear during the middle stage of the care-giving journey.  In the beginning, the illness is a consideration in lifestyle decisions, but not a main component.  However, as the illness becomes more severe, it becomes a major factor in how the person who is ill and their caregiver function on a daily basis.

As the caregiver continues on this path of support, they may be at risk for burnout depending on:

  • the severity of the illness or behaviour of the person they are supporting
  • if they feel able to handle situations that arise
  • the type of relationship the caregiver has had in the past with the individual (i.e. it is often easier to take care of someone with whom you have had a loving relationship)
  • degree of knowledge about the illness
  • level of quality support (informal, formal and professional).  The more support, the less risk for burnout.

Based on what we know about Marion and Dorothy, we can assume that Dorothy may not be at a great risk for burnout, if she is careful.  When Marion was first diagnosed, both women did a lot of research into COPD.  Because of Dorothy’s connections in the health care field, she was able to put supports in place well in advance of them being needed.  The couple had been in a loving, stable relationship for a number of years and were committed to supporting each other through the illness journey.

However, not every caregiver has the resources that Dorothy was able to access.  What are the symptoms of burnout?

You May Be Experiencing Caregiver Burnout If…
  • You have developed a new health problem.  If we don’t practice self-care, taking care of a loved one can stress our immune system, causing our own health to suffer.
  • Depression.  At times we can feel that the situation is hopeless–especially if we know that our ‘person’ isn’t going to get better.  Feelings of being overwhelmed, overtired and under appreciated can all lead to depression.
  • Anger.  While anger is a normal response to life not turning out as we had wished, excessive anger is a warning sign of burnout.
  • Substance Use.  Care-giving is difficult and we all have our own ways of coping or self-soothing.  However, using substances as a way to make yourself feel better is not a healthy way of self-care.
  • Social Isolation.  Social isolation can be a vicious circle.  We may have to stay home all the time in order to be there for our ‘person’–especially if there are no supports in place to give us a break.  However, the more isolated we become, especially if depression sets in, the less time we want to spend out in the world.
  • Loss of Relationships.  This is directly related to the degree of social isolation you may be experiencing.
  • No interest in self-care.  If you are not eating well, taking time to exercise or spend some time doing activities that you enjoy, burnout may be the reason.
The Story Continues…

Through forethought, planning, good communication with Marion and lots of support, Dorothy was able to avoid experiencing serious burnout.  Of course there were days or weeks when she felt overwhelmed, but because she felt that the care she was providing for Marion was important, she was able to get through the rough patches.

By this time, Marion was housebound due to exhaustion.  Her medication wasn’t as effective as before and for various health reasons she wasn’t a candidate for surgery that is sometimes an option for COPD patients.  Due to her lack of energy, Marion spent a lot of her day sleeping.

If someone had asked Dorothy how she was doing (we don’t often ask the caregiver, but instead focus on the person who is ill), she would have responded that she is able to handle the medical piece because of her nursing training, and the house chores as they can afford to hire help when needed.  Her biggest heartache is that she misses Marion (the ‘old’ Marion).  She misses having someone to go out with and share experiences with.  Marion isn’t psychically absent, but she sleeps most of the time, so isn’t always available.  Dorothy wonders when she stopped being Marion’s partner and became her full-time nurse.

This sense of loss is common for caregivers.  Even if they have support for the practical things, the grief experienced around this is often lonely and hard to explain to others.

What’s a Caregiver To Do?

Does the above list describing burnout sound like you?  Can you relate|?  If so, there are things that you can do.

  • Ask for help from other family members, friends, medical supports, etc.  As humans we often feel that we can do it all by ourselves, or that no one else is able to take care of our ‘person’ as well as we can…and we can’t and other’s can (though it may look different from how we would take care of them).  Do yourself and them a favour and get some support.
  • Check into support groups for the type of illness/condition that your loved has.  Many groups, such as the Alzheimer’s Society and Hopespring Cancer Support Centre offer support groups for patients and their caregivers.  Your medical supports may be able to provide advice on where to look or check out the web.
  • If you are feeling housebound due to your care-giving role,  and are computer savvy, there are on-line support groups available.
  • Let your doctor know that you are struggling–especially if you are feeling depressed, using substances or other unhealthy means as a way to cope.  There are things they can do to help by suggesting medication or referrals to other professionals.
  • No matter where you are on the care-giving journey, counselling is always an option as a tool to help you cope with negative emotions (such as anger) that can come up, inappropriate ways of coping, feeling socially isolated.  Having an impartial third party to talk to about what is going on, can release some of the stress and pressure that you feel.
The Story Still Continues…

Marion and Dorothy are still living in their home.  Marion’s health continues to decline, and Dorothy has come to terms with her ‘new’ relationship with her.  At Dorothy’s request, family members have started taking on a more active role in Marion’s care.  More and more household duties are being done by paid help or family members.

Dorothy is still grieving the loss of the ‘old Marion’ and recognizes that this is reality. She is thankful that she is able to provide so much care for her partner.

And now, let’s lighten the mood.  For those of us who are trying to figure out summer plans for our children, here’s a classic camp song from Alan Sherman…Enjoy!

Part 3

 

 

 

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The Caregiver’s Journey–Part 1

I recently attended a one-day conference (organized by Hospice Waterloo Region) for caregivers and professionals who support them.   As I sat with the other participants and heard the stories of people who are actively being a ‘care partner’ for a loved one(s), I was struck by the love and dedication that helped them to make meaning of the difficult role that they had agreed to take on.  I was also aware of the feelings of exhaustion, frustration, fear, and loneliness that many bravely shared as they told their stories.  This is the first in a three-part series on Care-giving.

The information in this post is a partial summation of information that was presented by Dr. Virginia Wesson, Psychiatrist and Dr. Rhonda Feldman, Psychologist.   Both Drs. Wesson and Feldman see patients, and their families, at The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer’s Support and Training.

The Caregiver’s Journey

According to data presented that day, there are 3.3 Million caregivers in Ontario.  Of those, 500,000 of them are ‘young’ caregivers (falling between the ages of 6 and 25).  If as a society we were asked to pay for the caregiving services provided free-of-charge by loved ones, the bill would be in the Billions of dollars.  Wow!

Based on the numbers, if we are not personally affected by the need to take care of a family member or friend, then we know someone who is–a friend, co-worker, other family member…the list goes on.  As people in our circle, how can we support them as they support others?  I suggest that a first step is to understand the path that they are walking.

Dr. Wesson believes that there are three stages to the caregiving process:  the early stage, the middle stage and the late stage.

The Early Stage

When a partner, spouse, close friend or family member has been diagnosed with a debilitating illness we often experience shock and grief.  While we may have suspicions that our ‘person’ has been struggling, having it confirmed can still be devastating.  We don’t know what the future really looks like, and we may feel that we are starting an ‘endless’ journey.

If we are the primary support, we can be overloaded with information by medical staff or our own research.  On the other hand, we may feel that we are being provided with little information and not sure where to turn.

Once the initial emotions subside, and if the disease in question is progressing slowly, the illness may intrude in our life, but we are able to carry on with a sense of normality.  You may be providing more emotional support vs. physical support for your loved one, taking on more of the hands-on chores that may now be more difficult and becoming a ‘manager’ of the care required by your loved one (i.e. managing medical appointments).

Coping Strategies for the Early Stage

It is during the early stage that you can start to put supports in place for the future.  Will there be physical changes that need to be made to your surroundings?  Are you aware of community organizations that can be called upon when needed?  How may other family members or friends can be asked for help?  What do you need to take care of yourself–such as self-care activities?

This is the time for planning.

The Middle Stage

By the time you have reached the middle stage, you have realized that your loved one isn’t going to get better.  Their illness is a constant consideration as you plan your day–both personally and professionally.  Some people may have decided to leave their jobs, or scale back their hours of work.  Many may be coping with the financial stresses brought on by the illness–either through loss of income or rising expenses.

Feelings of loneliness and overwhelm can be common at this stage–especially as your world is shrinking due to care-giving responsibilities that never seem to end.

Coping Strategies for the Middle Stage
  • Be realistic about what you are able to do.  Don’t be afraid to ask for help.
  • If you have not done so already, now is the time to call on your support system for help…friends, family members, outside organizations.
  • To the best of your ability, keep up with your self-care practices–eating well, exercise, and any activities that help you to cope.
  • Be aware of the abilities of your loved one, due to their illness.  It may be less frustrating when we understand that their actions are due to physical challenges vs. negativity.
  • Try to find any positive aspects or meaning in the care-giving role.
The Late Stage

By this stage, caregivers may be feeling that “I can’t do this anymore”.  If they have had little or no support, they may be suffering from burnout.

There may be feelings of both internal and external conflict as the need to make decisions start to arise.  Internally, there’s the struggle between the guilt you could be feeling as it becomes more difficult to take care of your loved one in their home and the possibility of them moving into a place with full-time paid staff; and the recognition that continuing the current way of doing things is becoming impossible.

Family conflict may come into play if family members are not agreed on next steps, or resentments have come out regarding the sharing of care-giving duties.

Coping Strategies for the Late Stage
  • As above, be realistic about what you can do…physically, mentally and emotionally.
  • Look to your medical supports for information about what can be expected during the late stage of illness and how much care will your loved one require.
  • Access mental health support either privately or through community organizations that specialize in your loved one’s illness.  Organizations such as Cancer Support Centres, Alzheimer Society, etc. have care-giver support groups.

While it may seem like it, as a care-giver you are not alone…no matter where you are on the journey.

Next week, we’ll look at care-giver burnout and further ways to cope.

And now…a TED talk on the positive effects of exercise on the brain…Enjoy!

Part 2

Part 3

 

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Are You Ready to Change? Let’s Find Out!

One of the concepts in Buddhism is that ‘everything changes…nothing stays the same’.  While I have found this to be true, change can come in different ways.  Sometimes it’s foisted upon us, and sometimes we are the initiators.

The focus of this post is on changes that we put in place, and specifically, the mindset and process (Stages of Change) that make self-directed change possible.

Meet Phil…

Phil (age 60) has lived through a difficult five years.  His troubles started when the manufacturing company where he had worked since high school shut down, and he was unable to find a comparable job.  Phil, already somewhat of a curmudgeon, became more so as he chose to spend endless hours at home.  His wife, Joanne, worked long hours–leaving Phil alone for most of the day.

While he wouldn’t admit it, Phil missed his job and work friends.  However, he didn’t feel like getting in touch–it was too much effort.  Phil spent most of his days feeling angry, sad, lonely and incredibly bored.  Joanne suggested that he could take over some of the household responsibilities (it would make her life easier), but Phil believed that he hadn’t cooked dinner before, so why start now?  Instead, Phil started spending hours of his time on the internet watching episodes of his favourite 1970’s tv shows on or napping on the couch.  Due to his inactive lifestyle, Phil gained a lot of weight.  The more weight he gained, the less active he became.  Eventually, Phil decided that he didn’t care if he ever worked outside the home again and fell into a rut.

The second blow fell two years later.  Joanne, frustrated with Phil’s behaviour and tired of working long hours with little household or emotional support, decided to leave their relationship.  Phil was surprised as he didn’t think there was a problem.  He believed that Joanne wasn’t really going to leave, she was just mad because he wasn’t helping around the house.

Today, three years later, the couple are divorced, and Phil is living in a small apartment.  His lifestyle hasn’t changed.  If anything, he has moved from being a curmudgeon to being bitter.

The Stages of Change

According to the Stages of Change theory, there are five steps that we move through to make successful and lasting changes: pre-contemplative, contemplative, preparation, action and maintenance.

Using Phil as an example, it’s clear that he’s in the pre-contemplative stage.  While Phil is feeling bitter, chances are that he doesn’t want to change.  In fact, he may not even realize that he has a problem.  Phil has continued his lifestyle because on some level he believes that it’s working for him.

Back to Phil…

One day Phil returned from the store to discover that the elevator in his building wasn’t working.  This had never happened before!  As his apartment was on the third floor, Phil decided to take the stairs.  By the time Phil reached the top of the first flight, he decided to leave his shopping bag in the stairwell as it was ‘too heavy’ to carry.  Walking up the second flight, he decided to stop halfway to catch his breath.  Anyone watching would have seen Phil crawling up the third flight on his hands and knees–breathless, his face red and covered in sweat.

Reaching his apartment, Phil was scared.  What had happened to him?  What if his unit was on the fourth or top floor?  He wouldn’t have made it.  For the first time, Phil wondered if something might be wrong.  Phil had entered the contemplative stage.

The Contemplative Stage

People in the contemplative stage have started to understand that there is a problem and that maybe they need to do something.  This is the pro vs. con stage.  Phil may be thinking, “I’m out of shape”.  “What if the elevator breaks again?”  “What will I have to do to get back in shape?”  “To get back into shape, I might have to give up my daily bags of chips, but if I don’t, I may die in the hallway!”

During this stage, no action is being taken, but things are bubbling below the surface.  This stage can last a long time because we over-estimate the benefits of staying where we are and think that changing will require too much effort.

Phil Moves On…

Eventually the level of fear that Phil experienced that day decreased.  Once the elevator started working, he was able to get his bag of chips from the stairwell.  He didn’t change his behaviour, but each time he reached for a salty snack he remembered sitting on the flight of stairs, unable to move.

Phil started to become aware that he sometimes found it hard to get up from the couch or was out of breath if he stood for too long.  Putting on his pants, he noticed that his belt was on it’s last hole–how did that happen.  Perhaps it was time to do something!  Phil had reached the preparation stage.

The Preparation Stage

During this stage the person wanting to change is moving to outward behaviour–not only do they want to make a change, they are coming up with a plan.  For Phil, this meant using the internet to find ways to get back into shape.  He searched for blogs written by older men who were doing what he was thinking of.  He figured out that he would need to lose some weight, so he started researching a healthy weight for someone his age.  Realizing that he would need to move to a healthier diet, Phil called a ‘skinny’ friend to find out what he eats.  He decided to buy ‘one of those gadgets’ that will tell him how many steps he’s taken.

After all his research, Phil came up with his plan.  He decided that for two weeks, he would cut back to one bag of chips a week, walk 1500 steps a day around his apartment, and add a daily salad to his diet.  Phil decided that he would start his plan on June 1.  Phil was on his way to the active stage.

The Action Stage

At this stage, the person is changing their behaviour–making the change.  This is the exciting stage as it becomes clear that something is happening.  The person is committed to the change and is starting to reap the benefits of their first actions.  A positive feed-back loop is created…a behaviour change is made…a benefit is noticed…motivation to continue is created…

Unfortunately, this is also a dangerous time in the change process.  In the honeymoon phase of action, people can sometimes underestimate the amount of effort it takes to continue new behaviours over the long haul. It’s important to note that a change hasn’t been accomplished until you are able to maintain it.

Let’s Check In on Phil…

On June 1, Phil was ready to go.  He had his ‘gadget’ and a week’s worth of salad greens were ready in the fridge.  Seven servings of potato chips were packaged for his daily treat.

At the beginning, 1500 steps felt like running a marathon.  His daily bag of chips seemed to grow smaller as the days went by, and he decided that salad wasn’t his favourite food.  However, by reading blogs from others who were also working to improve their health, Phil was able to stick to his plan for the first week.

The second week didn’t feel as difficult, and one day he noticed that he had walked 2000 steps without really trying.  Near the end of that week, Phil decided that he wanted to create a new plan for the next two weeks.  He repeated this process and, after six months, Phil’s fitness level had improved, he had lost some weight, and spent more time out of his apartment.  His mood had improved.

All was going well until…

Welcome to the Relapse

One day Phil woke up and he didn’t feel like doing his walk through the neighbourhood.  He hadn’t slept well the night before and was in a bad mood.  This had happened before, and he had been able to move past it.  Today, something was different.  As he lay in bed he thought about all he had accomplished over the past six months he felt tired.  It suddenly occurred to him that if he wanted to keep in shape, this was a life-long project.  As a wave of overwhelm flooded over Phil, he decided to take the day off.  “No salad for me today!”  “No walk and I’m going to treat myself to two portions of chips!”  Phil felt better immediately and enjoyed his “day off”.

Sadly, as often happens, one day turned into a week, then two and before he knew it, Phil had slid back into some of his old habits.  It was only having to move to a bigger belt hole, that shocked Phil back into reality.

Relapse is very common as we work on making a change.  Once we realize that we need to keep working in order to make a change permanent, or we become over-confident that the change is permanent, and we don’t have to be aware of our behaviour any longer; we run the risk of losing ground.

However, all is not lost…there is the maintenance stage.

The Maintenance Stage

The purpose of the maintenance stage is to avoid relapse and consolidate the benefits that have started to pile up during the action stage.  It is during this stage that, based on what we have learned in the action stage and any relapses, we discover the minor tweaks we need to make to the plan(s) in order to remain successful in our new lifestyle.

It is during the maintenance stage that we learn to be gentle to ourselves.

Phil Maintains…

As Phil recovered from his relapse, he realized that getting back to his routine wasn’t as difficult as he had thought.  He wasn’t starting from the beginning because he already had a plan and skills that he had developed throughout the previous stages.  Phil realized that it was unreasonable for him to be so strict with himself about his behaviour.  He wanted to think about ways that he could keep improving his fitness level and lifestyle changes while still taking an occasional break.

Over time, Phil stopped seeing his relapse as a failure and instead as a learning opportunity.

The Value of the Stages of Change Theory

In this post, I’ve created Phil’s story relating to his desire to change his behaviours in order to improve his health.  His change process can be used for any change that you would like to make.  This particular theory is often used to help people overcome substance/alcohol addiction.  As well, you can determine where you are in the change process (i.e. which stage) and have a road map of where to go from there.

And now…in a nod to 1970’s memorabilia…a classic from the Partridge Family…enjoy!

https://www.youtube.com/watch?v=wAXFkUaQoAs&start_radio=1&list=RDwAXFkUaQoAs

Please note:  Due to the upcoming Ontario provincial election, youtube appears to be airing political ads before showing their clips.  Blaikie Psychotherapy has no control over what clip is shown and isn’t aligned with any political party.

 

 

 

 

 

 

 

 

 

 

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Once We’re Gone…

Unless we are presented with an opportunity to think about our own death (a diagnosis, loss of a loved one, serious car accident), it isn’t something that most of us want to spend time doing.  If left to our own devices, we tend to imagine that we’ll live, if not forever, at least for a very long time.  However, once in a while, we are given a non-traumatic invitation to think about what will happen once we die.

A while ago I discovered Magareta Magnusson’s book The Gentle Art of Swedish Death Cleaning:  How to Free Yourself and Your Family from a Lifetime of Clutter in my local bookstore.  Having been somewhat captivated by the Marie Kondo phenomenon that swept North America after the publication of her book The Life Changing Magic of Tidying Up, I wondered if Magnusson’s book was going to be more of the same.  However, I was sold enough on the title to make the purchase. What followed was a trip I hadn’t expected.

Down the Rabbit Hole

This is a deceptively simple book.  It can be read in an evening.  Rather than finding directions on the correct way to fold socks and organize my closet, “Death Cleaning” took me down an existential rabbit hole.  It wasn’t only a matter of doing family members the favour of paring down my possessions so that they would not have to take on this task once I am gone–I’m somewhat of a minimalist, so the job should be fairly easy.  Instead, it forced me to look at the items that I have held on to from the perspective of those I have left behind.  Would they know the story of a cherished mug or why I kept a moth-eaten sweater?  What is the ‘value’ of my stuff?  Does it really matter?

As I pondered these questions, I was reminded of a scene from Margaret Laurence’s The Stone Angel.  Late in life, the main character, Hagar Shipley had her first manicure.  She was so astounded by the positive feelings she experienced during the treatment that, once her nails had grown, she kept the nail clippings in a match box as a reminder of being cared for.  After Hagar’s death, when her children find the box, they can’t understand why their mother would keep such a thing, and put it down to dementia.  Hmmm….

Not Everything Is the Same

Imagine that you are looking at your things through the perspective of your loved ones, after your death.  Some things we leave behind will spark feelings of humour (I can’t believe that Mom kept every card I ever sent!), confusion (a box of nail clippings?  Really?) or neutrality (the contents in the bathroom cupboard).  Unfortunately, some possessions are emotionally charged, and it is these items that require more thought and action.

A Story…

After their mother’s death, Sylvia and her older sibling Paul had the task of cleaning out the family home in preparation for sale.  Their father had died two years before.  As the siblings started working through the house, they were astounded by the amount of things that their parents had collected.  Neither parent had wanted to discard anything, and the house was a museum of their lives together and as a family.

Over time, many car loads of items were taken to charity shops. Family members and friends were invited to choose an item to remember the couple by.  A dumpster was placed in the driveway to get rid of decades of newspapers, magazines and assorted other ‘junk’.

On most weekends, the siblings worked together on this project.  It was going well…until…they found…THE BOX.  Hidden in the back of a closet was a box of journals written by their father.  They covered the years from being newly married until Paul’s birth.  Sylvia and Paul were excited to discover a record of their beloved father’s thoughts and feelings and looked forward to learning more about him–in his own words.  Unfortunately, as they read, their excitement turned to hurt and confusion as they realized that their father had never wanted to have children, but did so as a concession to their mother–whom he had loved deeply.

Suddenly their relationship with their father came under the microscope.  Did he change his mind?  Did he ever love them?  Was the time he spent with them only to please his wife?Since they already had one child, was Sylvia planned?  Because both parents were dead, all these questions were left unanswered.  The siblings could be trying to come to terms with this information for the rest of their lives.

When We’re Ready the Teacher Will Come

As I continued to look at my possessions from the perspective of not being able to explain them to those I leave behind, asking myself what (if anything) I should get rid of now in order to spare them any future pain or misunderstanding; I met Jill Sadler.

Jill is the owner and principal consultant of Parosol.  She describes her company as “estate planning redefined”.  Parosol’s promotion material explains:

“We work with you to document and create a complete care, legacy, health and aging plan that you can share with the important people in your life–making sure your wishes are known and you are in control of your future.”

I wasn’t looking for Jill. Yet she came across my path as I was asking myself difficult questions about how to make decisions easier for my family if I was no longer able to provide direction or explanations.  As I learned more about Jill and her company, I realized that she would be a valuable resource as I move along this path.

Your Mission, If You Choose to Accept It

While the story of Paul and Sylvia is fiction, unfortunately their experience isn’t uncommon.  I have worked with many clients who struggle with information learned after the death of a family member or with having to make decisions without knowing a loved one’s wishes.  And, as I learned from Jill, we don’t have to be dead to be unable to communicate what we want–an incapacitating illness will do it!

I encourage you, no matter your age or life situation, please take some time to look at your ‘personal’ belongings from the perspective of those you leave behind.  It may be a bigger bequest than anything you leave in your will.

And now…for those of you too young to recognize the last heading…some vintage Mission Impossible (before Tom Cruise)!  Enjoy!

 

 

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Is This Normal?

Another common question I hear from clients during therapy is “Is this normal?”.  According to the Merriam-Webster dictionary, there are many definitions depending on the area of ‘normal’ you are looking at.  Since we’re not talking about the areas of science or math, I’m using the definition of “conforming to a type, standard, or regular pattern” as a jumping off point for this post.

Individually, we often come up with our personal idea of normal by looking and comparing ourselves to others.  That’s how we determine what is the standard or regular pattern.  However, what happens when what we are experiencing is unlike that of our those around us?

Another Definition

Miriam-Webster also defines ‘normal’ as “occurring naturally“.  From a life perspective, I think that this meaning is more helpful, and forgiving.  Every person is an individual–with their own reactions, thoughts, and feelings.  These occur naturally based on our experiences.

In Buddhism there is the concept that we are the sum of our experiences.  We can be a mixture of the happy five year old and the despairing teenager; the ecstatic newlywed and the stressed parent; the toddler and the senior.  It all fits organically into who we are at this moment.  Therefore, while there can be a range of ‘normal’, I suggest that this range is very broad.  The challenge comes when ‘our normal’ negatively effects our life or the lives of those around us.  That’s when we may want to seek help.

The Only Constant Is Change

Another Buddhist concept is that everything changes–nothing stays the same.  This means that we are constantly in transition.  Sometimes the changes are minor–we gain or lose a few kilos, we need to change our route to work, a house plant dies.  At other times, the changes are major–we lose a partner, or we get sick.  Changes don’t always have to be negative.  Maybe a new member joined our family or we started a new relationship, moved to a new city.

Dr. Jon Kabat-Zinn, in his book Full Catastrophe Living writes:

“Even inanimate material is subject to continual change:  continents, mountains, rocks, beaches, the oceans, the atmosphere, the earth itself, even stars and galaxies all change over time, all evolve, and are spoken of as being born and dying.  We humans live for such a brief time, relatively speaking, that we tend to think of these things as permanent and unchanging.  But they are not.  Nothing is.”

“The point is that life is constant change from the word go.  Our bodies change in countless ways as we grow and develop over the course of a lifetime.  So do our views of the world and of ourselves.  Meanwhile the external environment in which we live is also in continual flux.  In fact, nothing at all is permanent and eternal, although some things appear that way since they are changing so slowly.”

So if everything is in constant change, how do we find normal?

Coping With Change

When we think of change/transitions the concept of resilience comes to mind.  Resiliency is our ability to adjust and recover.  We build our resilience by practicing self-care (sleep, diet, exercise), having realistic expectations about what we can do, avoiding toxic thinking, being able to cope with ambiguity and uncertainty and developing a support system.

When we are able to cope, we are working towards a ‘new normal’.

A Story…

Peggy was an 84 year old woman who had lived in her home for 60 years.  When she arrived to the house as a newlywed, it was a mess.  The previous owner had let the place go, and it was in much need of repair.  Peggy and her husband Ron renovated the home themselves–learning the necessary skills as they went.  Once their children were born, the house moved from it’s new pristine condition to the patina caused by a busy family.

Peggy’s memories were tired to her home.  She could tell  you the origin of each bump on the wall or scratch on the floor.  When working in the kitchen, she could “see” the face of her late husband sitting at the table.  Peggy could “hear” the hurried footsteps of her children as they raced up and down the stairs.  On cold days, she could feel the draft coming through the living room window–the window that had defied their attempts at weather proofing.

Change Arrives

One night, Peggy awoke to the smell of smoke.  Looking outside her bedroom, she saw that the hallway was filled with smoke.  Peggy called 911 from her room and fire fighters were able to rescue her through the window.  As Peggy stood outside, it was clear that the house could not be saved.  The property was well insured.  Peggy would be able to afford a new place, but her home and many of her belongings were gone.

Peggy moved in with her son while the insurance was being settled.  Because she liked her privacy and independence, Peggy knew that living with either of her children was a short-term solution to her housing situation.  After a few months, Peggy found an apartment that she liked.  It was close enough to the library and her favourite grocery store that she could walk there when she wanted to.

The months between the fire and actually settling into her new home were busy. Peggy was distracted from thinking in any great depth about what had happened.  However, once the last of her new furniture was in place and all was quiet, the enormity of the change hit her.

Now what?

The New Normal

How many times have each of us, after a major change, said…”When things get back to normal…”?  But what if the change, like Peggy’s, is the new normal?  What if we have experienced a life-changing event?

Major changes, even good ones, usually involve loss.  Peggy’s loss is easy to see–her home and possessions.  However, some are more difficult to determine, and may not become apparent until we are faced with post-change life.

While Peggy liked her new apartment and it’s proximity to places she regularly visited, she missed the walk through her old neighbourhood.  She was accustomed to checking on the progress of her friends’ gardens or greeting the cat who lived on the corner.  At the beginning Peggy was a little late for appointments because she forgot to factor in the time it took for her to get from her unit to the parking garage.  In the kitchen, preparing meals too a bit longer as she had to hunt to find utensils that were in new places.

Everything felt difficult and feelings of grief began to emerge.

The Mourning Process

When we experience a loss, grief is a natural response.  For Peggy to be able to be able to move to and embrace her new normal, it was important for her to work through the tasks of mourning.  Peggy’s next steps:

Task 1:  Accept the reality of the loss.  Peggy has already started this task as she spends time in her new apartment and becomes aware of how much has changed–both large and small.

Task 2:  Process the pain of grief.  The key to completing this task is to give ourselves permission to feel pain.  Rather than turning away, we acknowledge that we are hurting and missing what we have lost.  When we pay attention to our pain, we may notice that it has isn’t as sharp as before, or doesn’t visit as often.  During the first year in her new home, Peggy would often find herself caught up in a grief cycle, as she moved through the “year of firsts”.  She discovered that if she sat with her tears, they would eventually subside. Peggy learned that she would feel sad leading up to a major family event or holiday.  These celebrations now took place at her son’s home as she no longer had the space.

Task 3:  Adjust to a world without what was lost.  As time went on, Peggy found that she thought about her house less often.  The depth and frequency of her sadness started to ease, and she started to think about what a future in her new home could look like.

Task 4:  Start a new life, while keeping a connection to what was lost.  One day Peggy was surprised to notice that she was looking forward to her walk to the library.  She had started to pay attention to the houses on her route, and was curious to see how a recently-started renovation was going.  When the next family event approached, Peggy suggested that it be changed slightly so that a new version could be held at her home.  As she became more comfortable in her apartment, she started to host smaller dinner parties for friends and family.  Peggy was starting to create new memories in her new home.

As Peggy became more comfortable and life felt less difficult, she was approaching her “new normal”.

 Embrace YOUR normal!

‘Normal’ can fit into a broad range of thoughts, feelings and behaviours. So long as your normal isn’t negatively affecting you or others; then I suggest the wisdom of accepting what currently is.  Life can be stressful enough without comparing ourselves to others and questioning ourselves when our normal is different from someone else’s.

And now, a lesson in ‘normal’ from SpongeBob SquarePants…enjoy!

 

 

 

 

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Welcome to the Transition!

Traditionally, in Western culture, we often think of January 1 as the beginning of a new year, but for me it’s always been the day after Labour Day.  Just like the week before December 31 is taken up with New Year’s Eve preparation, for me, the days leading up to the first day of school involved choosing new supplies, deciding what to wear and checking the school office window to discover the name of my new teacher.

Living in a city that is home to two universities, it’s clear that the September start of a new year doesn’t only apply to children, but to young adults as well.  The beginning of their new year is obvious as the streets become filled with U-Hauls and the traffic in the city core picks up.  For some (and their families) it’s not only the start of a new year, but the start of a new life–with lots of feelings of excitement and trepidation. Continue reading Welcome to the Transition!

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