Category Archives: Self-Care

Art Therapy and Mental Health…Have you Doodled Today?

As we look for ways to improve our mental health, mindfulness exercises such as colouring seem to be gaining in popularity.  The following post from the archives speaks to this, as well as giving an exercise to try.  Enjoy! 

If you have been out in the world over the past year, you may have noticed the increase in the number of adult colouring books for sale.  They are everywhere!  You can pick one up when buying your groceries, refilling prescriptions or waiting for your flight at the airport.  They cover a range of topics, disciplines, genres, moods, spirituality and life events.

In the October 2016 issue of Psychology Today, Emily Silber reports that an estimated 12 million colouring books were sold in the U.S. in 2015, up from 1 million in 2014.

When reflecting on the growth of this popular item; Silber quotes clinical psychologist, Ben Michaelis, who suggests that “even if colouring does not help people process negative feelings directly, it may a least offer an effective form of relief”.

Art Therapy

While some people may balk at this popular culture activity, using adult colouring books could be considered a form or art therapy.  The Canadian Association of Art Therapy describes art therapy as “the combination of the creative process and psychotherapy, facilitating self-exploration and understanding. Using imagery, colour and shape as part of this creative therapeutic process, thoughts and feelings can be expressed that would otherwise be difficult to articulate.”

While art has been used since the beginning of human history as a way to share thoughts and ideas–the oldest cave painting was found in the El Castillo cave in Cantabria, Spain and dates back 40,000 years to the Aurignacian period–art therapy, as we know it, didn’t really start until the 1940’s.  The original art therapists were artists who recognized the value of creation on their own mental health, and chose to share the creation process with others.

If you are interested in a detailed history of art therapy, you can check out Art Therapy Journal for a wealth of information.

But What If I’m  not Creative and Can’t Draw?

While I am not an art therapist, in the past, I sometimes suggested a ‘drawing practice’ to clients–especially if they were working with anxiety and/or depression–as a way to calm their thoughts and shift their focus.  One of the most common responses that I heard was “I can’t draw” or “I’m not creative”.  The idea of being forced to create ‘art’ increased rather than decreased their level of anxiety.  So, instead I started suggesting a ‘mandala practice’.

What is a Mandala and How Do I Practice It?

Mandalas have been with us for a long time.  The word ‘mandala’ is Sanskrit for ‘circle’.  In Hindu and Buddhist traditions it is a graphic symbol for the universe.  Famous mandalas in the Christian tradition can be seen in the Celtic cross and rose windows.

In some traditions they have been used as part of meditation practices and some people believe that they have magical properties.  In fact, meditation paths are often built to form a mandala.

For people who don’t feel that they are creative (everyone is, whether they realize it or not!) or think that they can’t draw, a mandala practice is ideal as it is unstructured and free-form.  The practice doesn’t require a large outlay of cash for art supplies or take up a lot of space.  All that is required is a blank piece of paper, pen or pencil, pencil or regular wax crayons and a drinking glass or pot lid.  Intrigued?

The Mandala Practice

The way of this practice is to do it daily–similar to meditation practice or breathing exercises.  Besides being an enjoyable activity, there are many benefits to creating mandalas on a daily basis.  It is a way to step into mindfulness as you focus on the act of making your own mandala.  As you work, you may notice your thoughts slowing down.  As you engage the decision-making part of your brain, the emotional part of your brain may experience a sense of calm.  Clients have reported feeling a sense of accomplishment when they complete their mandala.  You are giving yourself the gift of a ‘time-out’.

There is no right or wrong way to do this practice–the value is in showing up.  It can take as much time, or as little, as you like.

Ready To Give It A Try?

Assemble the necessary tools (pen or pencil, blank paper, pencil or wax crayons, pot lid or glass) and find a comfortable place to work.

Step One
Empty out the box of crayons where you can see all the colours and easily reach them. This is easy if when sitting at a table.  Take a minute and appreciate the range of colours.  Think about the colours that you are drawn to and those you shy away from.  Take a deep breath.

Step Two
Using the pen or pencil, on the blank sheet of paper, trace around either the glass or pot lid.  The goal is to have  a circle of a size that you are happy with.

Step Three
Look at the selection of crayons, and without over-thinking it, choose one that appeals to you.  Using that crayon draw a shape inside the circle.  It can be anything you chose.  When you feel that the shape is complete, stop and return the crayon to the pile.  Take a deep breath.  Select another crayon and either add to the shape, or create another shape inside the circle.

Step Four
Continue  Step Three, until you feel that your mandala is complete.  Again, don’t overthink it.  You’ll know when it’s finished.  The circle may be filled, or it may only have one or a few items in it.

Step Five
Initial and date the mandala and file it way.

When you develop a regular practice, over time, you will have a collection of mandalas.  It is often interesting to look back over the series (several months’ worth) to see how the drawings, colour choices and subjects have changed.

Most of all…have fun!

Ultimate Mandalas–Made of Sand! 

As well as having my own mandala practice, I have been fascinated by the Tibetan practice of making sand mandalas. Their creation and destruction can be viewed as the ultimate expression of impermanence and love for the benefit of others.  Below are two clips showing this amazing act of creation.  The first gives a sped-up overview of the process. The second shows the process in more detail.

Enjoy!

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The Precariousness of Balance

When people find out that I publish a blog post on a regular basis, they often ask where I find ideas to write about.  I share that the inspiration can come from lots of different areas.  Sometimes it’s a book or article that I’ve read. Sometimes a discussion with a friend, colleague, client or stranger has been the spark.  And then there are posts that  I write as a way to wrestle with a topic that I am puzzling with…such as today’s post on balance.

What is Balance?

The Merriam-Webster dictionary defines ‘balance’ in a number of ways…

  • as a piece of equipment used for measurement
  • physical equilibrium (keeping your balance on a sailboat)
  • the equal space between two opposing elements (junk food vs. exercise)
  • in the context of art, balance is an aesthetically pleasing integration of elements
  • an amount in excess especially on the credit side of a bank account
  • mental or emotional stability.

The ideas of physical equilibrium, space between opposing elements and mental/emotional stability are somewhat helpful, but they don’t quite fit what I’m looking for.  They are describing an exact point, but life is made up by a series of ‘points’ or moments.

Balance as a Concept

At some point during the time that a client and I are working together, we will talk about how things may be different when they have finished therapy.  What is their picture of life after ‘the change’?   In order to discover your view ‘balance’, substitute ‘balanced’ for ‘finished therapy’ or “What is your picture of life after you have achieved a level of balance?”  I suspect that each of you will answer differently.

When we recognize that what is an ideal balance for one person, is completely out of balance for someone else, it becomes clear that ‘balance’ as a concept is incredibly individual.  Also, what a balanced life looks like at one stage of life no longer fits at a later stage.  To complicate things, that sense of being balanced can change from one day to another depending on energy levels, weather, people contact, or an endless bunch of other factors.

Finding Balance…By Paying Attention to the Opposite

I wonder if being able to live a balanced life requires a certain level of self-awareness…knowing not only when we feel balanced, but also being aware of when we feel ‘off-balance’.  Feeling ‘off balance’ is one of the most common reasons that people begin to see a therapist.  They may not be sure what is going on, but they don’t feel ‘right’.

Similar to the old saying, of “If it isn’t broken, don’t fix it.”, maybe we don’t recognize that we are living a balanced life, because everything is ticking along nicely.  We are living our lives with few problems.  We look for balance only when we become aware of it’s non-existence.  Then we play the game of adding more of this and less of that in an attempt to bring back feelings of equilibrium.  How many of us have thought that “I just need more sleep… or less work, or more fun, or less … and life will be better”.

Once we can imagine what a balanced life looks like for us…what we are aspiring to…how do we get there?

Tools for Living a Balanced Life

It appears that the search for a balanced life has been a human activity for a long time.  Here are some of the tools that I have found:

  • The 80/20 Rule:  The idea behind this tool is that when looking for balance it’s unnecessary to micro-manage things in your life or constantly correct when things feel a bit off-kilter.  People use this as a way to balance spending (80% of total income) and saving (20%), or managing food.  If 80% of your diet is healthy, don’t worry about the rest.
  • The Buddhist Idea of the Middle Way:  The Buddha came to this idea after living a life of extremes.  In his youth, he was a wealthy prince, and then chose to give it up to live as a ascetic.  As a holy man, his practices were so extreme that he almost died.  As part of his spiritual journey, he discovered the value of living between the two extremes, or the Middle Way.
  • Everything in Moderation:  This tool fits with the Middle Way as the search for balance doesn’t preclude anything–just don’t do too much of it!
  • The One in/One out Rule:  This tool helps to maintain balance once it has been reached.  Basically, for every new thing you add into your life, something else must leave.  This could apply to things, people (in some cases) or activities.
Can We Have It All?

One of the reasons that many people search for a balanced life is their desire to have/or do it all.  But is this possible?  Maybe, but not at the same time.

Perhaps one piece to the search for a balanced life is that we need to expand the time-frame.  Rather than asking if we’re balanced in this week, month or year; maybe we can ask if we are living a balanced life at this stage.  Or what if the Merriam-Webster definition is right and balance takes place in the moment, only to shift out of balance so easily?  Hmmm….the search continues….

And now…an amazing display of balance–elegant, graceful and inspiring….Enjoy!

 

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The Benefits (and Challenges) of Slowing Down

Now that summer has truly arrived with a vengeance–+40 degrees with the humidity anyone?  Slowing down is something to think about. 

The following is from the archives.  Enjoy! 

A few weeks ago, I wrote about self-care and it’s importance for mental health. Part of self-care is giving ourselves permission to slow down. But what does “slowing down” look like?  I suggest that it will look different for everyone and that there are no shortage of resources to help us find our way.

 The Popularity of “Slow”

The first time I heard of “slow” was in the context of slow food.  In 1986 Carlo Petrini, an Italian, started a group that celebrated the concept and practice of enjoying local food, that is lovingly prepared, and shared with friends and family.  This group was in protest to a McDonald’s restaurant that was being built in his town.  Part of his plan, against what he saw as the encroachment of fast food into his fellow neighbours’ way of life, was to dismantle the McDonald’s at night (himself with a band of followers)–while it was being built.  The legal repercussions of this are another story, and included in the creation stories of the Slow Food Movement.

Since Petrini’s start in 1986, the Slow Food Movement has become an international institution that not only includes the founder’s initial plan, but also the idea of local eating, organic foods and beverages, as well as preserving various food preparation skills.

The slow movement has spread to the idea of slow money, slow fashion, slow cities, slow schools…the list goes on.

If you are interested in finding more information on this concept, the following books are worth checking out.

In Praise of Slowness:  Challenging the Cult of Speed by Carl Honore
Slow is Beautiful:  New Visions of Community, Leisure, and Joie de Vivre by Cecile Andrews.

 Sounds Interesting, But What Gets in the Way of Slowing Down?

Recently, a colleague and I were discussing self-care and why it’s so difficult to slow down–especially when it would be in our best interest to do so. She suggested that it comes down to being attached to outcomes. When we have a fixed idea of how things should be, we can become incredibly invested in making situations, people, etc. fit our ideal.

One way that outcome attachment is visible is when we have a picture in our mind of what we should be doing and how productive we should be.   This attachment can become a problem when we are fixed on a certain plan or idea and then react negatively when we can’t fulfill that plan.  Often our answer is to speed up rather than slow down in an effort to shape our world.

 How Can We Slow Down?

While slowing down looks different for each person, I suggest that in each case it involves letting go of our attachment to outcomes.  In Buddhist psychology, attachment (to states of mind, situations, our plans for the future) leads to suffering (pain in our lives). What would happen if we allowed ourselves to be less in control?  Would our lives start to have room for some ease?

The act of slowing down often takes deliberate effort.  In the April 22, 2017 issue of the New York Times International Weekly, there appeared a brief article by David Leonhardt entitled:  You’re Too Busy.  You Need to a ‘Shultz Hour’.  The article describes the habit of George Shultz (US Secretary of State in the 1980’s) to carve one hour each week for quiet reflection.  During that time he would think about the strategic aspects of his job, and ponder larger questions.

Similar to the book reviewed last weekSolitude:  A Singular Life in a Crowded World–the individuals Leonhardt interviewed in the article would agree with Solitude’s author Michael Harris about the negative impact that technology has had on the practice of slowing down.

Leonhardt writes:

“Whether you decide a Shultz Hour makes sense for you, I’d encourage you not to fool yourself into thinking that you can easily change your habits in little ways here and there. The ubiquity of smartphones, together with our culture of celebrating busyness, makes ad-hoc approaches difficult.  You are much more likely to carve out time for strategic thinking by making concrete changes to your habits.”

The author’s suggestion? Hide your phone…sounds easy, but how many of us could actually do it?

There are lots of bloggers that explore and chronicle their experiences of slowing down.  I recently discovered Cait Flanders, a blogger out of British Columbia, who has decided that 2017 will be her ‘year of slow living’.  Her posts are insightful and provide great tips.  I encourage you to check our her blog.

Slowing Down and Self-Care

Slowing down can be a key component of self-care.  However, the guilt we feel about taking things at a quieter pace, may defeat the purpose.  Often we have a fixed idea of what we want self-care to look like–get to the gym six days/week, floss our teeth daily, get to bed before 11 p.m…. The list can be endless, and we beat ourselves up when we haven’t been able to meet our self-care goals.  How will we be able to maintain the outcome we desire of being able to fit into a size 8 dress if we don’t push ourselves? How reasonable is this?

My friend and I decided that perhaps a better question is:  What do we need right now?  If the answer is something less healthy, spend the time to slow down and explore the feelings underneath the desire.  Am I really hungry, or do I need to sleep or talk to a friend about the challenging day I’ve had?

The Benefits of “Slow”:  A Real-life Example

In researching this post, I encountered a clip that told the following story.  An ambulance driver was taking part in a community group focused on the idea of ‘slow living’.  He decided to see what would happen if he drove slightly slower when rushing to an emergency call.  (I assume that he did this when it wasn’t an actual emergency!).  He found that by slowing down, he gave the drivers ahead of him more time to get out of the way, and he was able to reach his destination in less time than if he had increased his speed. Interesting… I wonder how much more productive we would be if we weren’t in such a rush.

To borrow a great line that I recently heard:  “You ain’t going to get all your possums up the same tree.”  My addition is, why rush around trying?

Now, if you have 20 minutes to spare, I invite you to take some time and listen to a Ted Talk from one of the ‘masters of slow’–Carl Honore.  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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Rest and Relaxation

The temperature is rising.  The birds are singing.  Trees are budding, and spring flowers are blooming.  Welcome to the first long weekend of the summer (even if the beginning of summer is a month away)!  Hopefully Mother Nature cooperates making outside activities a possibility.

Whatever your plans, I wish you a restful and enjoyable weekend.  See you next week.

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Depression Comes in Many Types… Meet Dysthymia

When my children was between the ages of 4 to 7, dinosaurs were of huge interest.  They were fascinated by all things prehistoric.  Not only could they identify many of these creatures (T-Rex, Triceratops, Stegosaurus…), they could tell you all about them.  Who knew there were so many types of dinosaurs?

We can think of depression in the same way.  Just like “dinosaurs” is a major category including many types, “depression” is a major category.  Some types of depression that you may already be aware of:  major depression, bipolar depression (also known as manic depression), seasonal affective disorder (SAD), postpartum depression, psychotic depression…  Who knew there were so many types of depression?  What about dysthymia?

Dysthymia

Dysthymia (also known as Persistent Depressive Disorder or PDD) affects up to 6% of the general population with women being three times more likely to be diagnosed than men (US stats according to Health Research Funding.org ).

This ‘dinosaur’ is characterized by a mild depression that lasts at least two years.  The symptoms are less severe than major depression, but are longer lasting or chronic.  Thankfully, the more severe symptoms that mark major depression—including anhedonia (inability to feel pleasure), psychomotor symptoms (particularly lethargy or agitation), and thoughts of death or suicide—are often absent in PDD.

Unlike other types of depression, dysthymia often goes under the radar because people are able to function.

Meet Agnes…

Agnes (a 30 year old woman) hasn’t felt ‘happy’ for a long time.  Even though she gets plenty of sleep (maybe too much, she wonders), she doesn’t have any energy.  At work, she has difficulty concentrating.  At home, Agnes can’t make decisions about simple things.  Unable to decide about what to have for dinner…most nights she stands in front of the fridge eating whatever comes to hand.  Healthy eating has become a thing of the past.  When Agnes thinks back over the past few years, she can describe a few weeks when the ‘fog’ lifted, but it always returns.  While Agnes is able to get through her days, she is starting to feel hopeless…that she will feel this way forever.

On the advice of a friend, Agnes recently talked to her doctor who, based on her symptoms, suggested that she may be suffering from dysthymia.

Am I at Risk?

If 6% of the population may suffer from dysthymia during their life time, am I at risk?  Let’s look at the five main risk factors:

  • A first degree relative (parents or sibling) has been diagnosed with depression,
  • You have recently experienced a traumatic or stressful life event,
  • Negative personality traits (e.g. low self-esteem, self-critical or pessimistic),
  • Personal history of other mental health disorders (e.g. antisocial, borderline, obsessive compulsive),
  • Being isolated or having a lack of social connections.

Having one or more risk factors doesn’t mean that you will develop dysthymia, but it does mean that you may want to take care of yourself.  But how?

The Power of Self-Care and Awareness

Working with clients who are learning to cope with any form of depression, one of the first things we do is talk about self-care.  When we take care of ourselves, we are healing current conditions and preventing future ones.  So what can we do?

  • Control stress:  Exercise, meditate, do an activity that you enjoy.
  • Reach out for support:  As people become more cut-off from each other, incidents of loneliness are increasing.  Think about developing your own support system.
  • Get help at the first sign of dysthymia:  Talk to your doctor or a therapist before your symptoms become chronic.
  • If you have already experienced and overcome dysthymia, consider long-term maintenance treatment to prevent a relapse.
Treatments

If you are currently suffering with dysthymia, there are two main areas of treatment:  prescription medication (SSRI’s such as Prozac, Paxil or Zoloft) and psychotherapy–specifically Cognitive Behavioural Therapy (CBT) that helps to change negative ways of thinking.

Dysthymia, or any other form of depression, doesn’t have to be a life-sentence.  There are things that you can do.

And now…I wonder if this well-known character suffers from dysthymia?  Enjoy!

 

 

 

 

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Boundaries Are Your Friend

For anyone who has had to deal with a troublesome nearby resident, they can understand the truth in the old saying “Good fences make good neighbours.”

Just as a fence is a physical boundary that allows for privacy and controlled interactions, emotional boundaries do the same.  In this post, we explore the wonder that is boundaries.

What are boundaries?

Simply stated, a boundary is a bottom line position, coming from an awareness of what we need and feel entitled to.  It takes into account the limits of our tolerance.  They are derived from our values and gut-level responses that define what we can accept in our relationships.

When we let others know what we will accept by setting limits, we are using boundaries.

Boundaries are not…

Melanie Beattie, in her book The New Codependency, explains that boundaries are not:

  • limits we set because someone told us to;
  • empty or angry threats;
  • attempts to control others;
  • limits we don’t or can’t enforce.
A Story…

Julie loved getting together with her friend Susan. The two women had met a few months previously when Susan moved into the neighbourhood. They had liked each other on sight, and would meet weekly at a nearby cafe to catch up on their lives, share stories and discuss current events.  However, after a few weeks things began to turn sour.  While Julie enjoyed their coffee dates, she started to feel annoyed by Susan’s frequent late arrivals.

At the beginning, Julie would dismiss her frustration as over-reacting.  It was only 10 minutes, and once Susan arrived the conversation would take over and all would be well.  In order to continue to enjoy her time with Susan, Julie started to make excuses for her friend–‘her life was busy’–‘she was unbound by rules, which was one of the things that made Susan so much fun’–‘she’s a free spirit’.  Eventually, these rationalizations stopped working, and Julie started to feel angry.

Julie had been brought up in a family where the consideration of others was a core value.  It was important to take other’s feelings into account when making decisions.  Behaviours such as punctuality were a sign of respect.  As Julie pondered these ideas and how they may be affecting her reactions towards Susan, she wondered what do to about this new relationship.  Should she stop meeting Susan for coffee?  What if she just put up with the status quo?  Maybe she should say something?

Why do we need boundaries?

We put boundaries in place for ourselves, not others.  For some people–especially those who identify as care givers–this idea is hard to wrap our brain around.  When I suggest the idea of setting a limit to clients, I’m often met with the response that to do so would be selfish.  However, boundaries are not selfish–they are a form of self-care.  Not only are they not selfish, but, when used well, can ease interpersonal interactions.

Sometimes we need to let our friends, family, coworkers, etc. know how we want to be treated.  Being able to clearly voice our boundaries is a way to do this.

Why we don’t have them?

In some families, boundaries are rare.  Being able to create and maintain boundaries is a skill, and if we grew up with adults who are unable to set limits, then we may repeat this family trait.  As children/young adults if we were able to start to put boundaries in place, and they were ignored by family members, then we often stop setting limits.  We learned that not having boundaries ‘normal’.  In order to learn about boundaries we need role models.

Other reasons why we may not have developed the ability to set limits:

  • We are overly dependent on others.  When we feel that we are unable to be alone or take care of ourselves, then we are more willing to accept negative behaviour from others.
  • We have low self esteem.  Perhaps we feel that we are not worthy of being treated well by other people, so we don’t set boundaries.
  • We don’t have the words.  Sometimes we are unable to find the words to express our limits.
  • We want others to like us.  If we care too much about what other people think of us, we may be afraid to risk their good opinion by putting boundaries in place.
  • We are “uber” caretakers.  As mentioned above, if we see boundaries as selfish, then we won’t enact them.
How to develop boundaries.

If we haven’t been able to develop the ability to create and set boundaries when growing up in our family of origin, all is not lost.  Like most skills, it is never too late to learn.  However, just as it’s harder to learn to ride a bike at the age of 30 than at age 5, learning to set limits in adulthood requires work and patience!

The first step is self-awareness–becoming in tune with our values and beliefs.  What is important to us?  How do we want to be treated?  What is acceptable?  No acceptable?

One way to finding the answers to these questions is anger.  Anger is a wonderful teacher as it shows us when our values and beliefs have been walked over.  In our story, Julie became aware of her bottom line about Susan being late because her value of punctuality and belief around respect were crossed.

Once we know what are boundaries are, it’s time to put them into words.  We’re defining a ‘bottom line’.  A standard way to do this is using the structure of “When you do this, I will do this”.  When creating a boundary it’s important that it be clear and enforceable.

The Story Continues…

After much thought, Julie decided that she valued her relationship with Susan enough that she didn’t want to end it before making an attempt to clear up this issue.  However, she was prepared to stop meeting with Susan if the tardy behaviour continued.

The next time the women met, Susan was late, and the following conversation occurred.

Julie:  “Susan, I really enjoy our coffee dates and getting caught up.”
Susan:  “Me too!”.
Julie:  “While they’re fun, I’m getting frustrated about your late arrivals.”
Susan:  “It’s usually only 10 minutes–15 tops.”
Julie:   “Ten to 15 minutes doesn’t seem to be a big deal, but in my family punctuality was important.  Being on time meant that you respected the person you’re meeting.”  So, in the future, I’m going to wait for five minutes.  If you’re late , then I’m going to continue on with my day.”
Susan:  “Hmmm…”

What happens when we set limits?

While we can control our boundaries and how we set them, we can’t control how they will be received.  Sometimes, other people hear what we are saying and accept our limit…all is well.  However, often things don’t run so smoothly.

If stating our bottom line is a new behaviour for us–especially in a long standing relationship–the other person could become angry, disbelieving or dismissive.  They may make attempts to make us feel guilty.

One common response is push back behaviour.   Push back behaviour is an attempt by others to test our limits to see if we are serious.  Are we going to enforce or follow through with what we said?  In some cases, the behaviour can become extreme as the other person hopes that the boundary setter will become so tired of the increased negative behaviour that they will give in.

While once understood, in some cases, push back behaviour can become almost humourous.  For example, a partner refused to do the couple’s laundry unless the other partner put the laundry in the hamper–leading to that partner to let the laundry to pile up to become laundry ‘mountains’!

Unfortunately, push back behaviour can become nasty and even dangerous.  Emotional and physical safety is a non-negotiable boundary.  If you are feeling unsafe, support is available by calling 911, the Sexual Assault Support Centre of Waterloo Region, Anselma House, Haven House and Mary’s Place.

The Final Chapter…

The next week Julie arrived at the cafe at the usual time. Susan wasn’t there.  As promised, Julie waited for five minutes and then left.  When Susan arrived 10 minutes later, she was told by the barista that her friend had come and gone.  Susan was annoyed and thought that Julie was being ‘childish’, but as she sat quietly with her coffee, she missed her friend.

The following week, Susan was only a few minutes late and apologized to Julie for her tardiness.

Julie still needs to enforce this limit as Susan doesn’t see punctuality in the same light as her friend.  In this way, Julie continues to enjoy her time with Susan without added frustration, and Susan knows what to expect if she is late.  As time evolved, the women were able to set up a system–when Susan knew in advance that she was going to be late, she contacted Julie ahead of time and they met a bit later.

And now…some great fence humour from Tim the Toolman Taylor…enjoy!

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The Path to Forgiveness

In this post, we explore the concept of forgiveness…What is it?  Who benefits?  Why is it important? And, most importantly, how do we do it?

The idea of forgiveness is a difficult thing.  When we have been disappointed or hurt by someone else our instinct is often to recoil and protect ourselves.  When a person close to us breaks our trust, the last thing we want to do is forgive them.  On the other hand, when we have hurt others, forgiving ourselves can be just as difficult.

However, in order for  true healing to happen, walking the path to forgiveness is a necessary journey.

What Is Forgiveness?

When we think of forgiveness, we may think of cheesy movies where by plot’s end, mortal enemies have become best friends–the closing scene showing them walking hand-in-hand into the sunset.  While this could happen in real life, forgiveness doesn’t usually look like this.

One way to describe forgiveness is to point out what it does not do.  According to Ron Pevny, in his book Conscious Living, Conscious Aging, forgiveness does not…

  • Mean that we have to ignore our hurt feelings.
  • Change the past, or assume that we have to forget what happened.
  • Mean that we have lost and the offender has won.
  • Excuse the act that did the wounding.
  • Absolve the offender of karmic or legal consequences.
  • Mean that we will resume a relationship with the other person–especially if it is not safe (emotionally or physically) to do so.

What forgiveness does is to provide the opportunity for healing and being able to move on with our life, without being limited by what happened.  According to Buddhist philosophy,  “Holding on to resentment is like picking up a hot coal with our hand with the intention of finding an opportunity to throw it at the one who has hurt us.”.

In The Book of Joy, Archbishop Desmond Tutu states,

“Forgiveness is the only way to heal ourselves and be free from the past.  Without forgiveness, we remain tethered to the person who harmed us.  We are bound to the chains of bitterness, tied together, trapped.  Until we can forgive the person who harmed us, that person will hold the keys to our happiness, that person will be our jailor.  When we forgive, we take back control of our own fate and our feelings.  We become our own liberator.”

When we can forgive, we are able to stop labeling our self as a “victim” and move forward from a place of growth.

Holding on to negative events that lead to ongoing feelings of resentment, anger, hostility may undermine our health.  In one study, psychologists asked people to think about someone who has hurt them, while monitoring their heart rate, facial muscles and sweat glands.  When people remembered these grudges, their heart rate and blood pressure increased.  However, when they were asked to think about forgiving these people, their stress responses returned to normal (Book of Joy, pg. 237).

Steps to Forgiveness

While it seems obvious that forgiveness is a good thing–for our physical and mental health–how do we do it?  Especially since rehashing the juicy details of past hurts can provide an addictive energy rush.

It’s important to remember that forgiveness is a process; one that is repeated over and over as new feelings and details arise as we work to let go.

Pevny breaks down the path to forgiveness into the following five steps:

  1. Uncovering and feeling what happened.  Before we can forgive, we need to be clear about what we are forgiving.  It’s important to explore the actual event–what were the circumstances?  Who said what?  What emotions did you feel?  Take your time and be gentle with yourself.
  2. Committing to forgive.  Forgiveness is a choice–sometimes a difficult one.  When we have held on to resentments for a long time, they become part of our story.  Forgiveness is choosing a new story.
  3. Humanizing the offender.  Forgiveness begins to happen when we are able to separate the person from the action.  To do this requires compassion and the ability to see the situation from the other person’s perspective.  Maybe there were things going on that you didn’t know?
  4. Honestly looking at your role in relation to the situation.  This is especially challenging when the emotions are still raw, so it’s useful to use your logic vs. emotions.  Human relationships are never simple.  As my grandmother used to say “It takes two to tango.”
  5. Forgiving and continuing to forgive.  Forgiving is an act of will–we choose.  This act will play out differently for each person.  For some, it’s a private, quiet letting go.  For others, they want to meet with the person involved and voice their forgiveness.  No matter how it manifests, forgiveness is an ongoing process.
What If I Need to Forgive Myself?

When we have hurt others, the feelings of guilt and shame that we carry can be overwhelming.  While we may be able to show compassion to others, doing so to ourselves is more difficult–if not impossible as we’re our own harshest critics.

Pevny suggests that the five steps are applicable to those working on self-forgiveness, and may include specifically asking for forgiveness from those we have hurt (if possible and appropriate).  However, sometimes the person we have hurt is ourselves.  Pevny writes:

“In a great many cases, what needs self-forgiveness is not harm done to others but personal weaknesses or perceived choices or actions that we feel have damaged our own lives.  Self-forgiveness depends upon our willingness to carefully examine our choices and actions and, in many cases, acknowledge that we did the best we could with the awareness we had at the time.  If we see that we did not do the best we could, it requires that we use our regrets not to berate ourselves but as important guideposts on our journeys into a positive, conscious future.  The biggest catalysts for our growth are often (perhaps mostly) what we learn from our mistakes, weaknesses and poor choices.”

Rewriting our Stories…Sometimes We Need Help

Whether we need to forgive ourselves or others, walking on this path gives us the opportunity to rewrite our story–and sometimes the stories of others.  And we know that the journey isn’t easy.  Self-care is important.  If you start on this journey and feel that you are losing your way, please reach out to a trusted friend, family member or professional to provide support.  Sometimes, our hurts are too big walk up to on our own.

And now…a quick lesson in self-compassion.  Enjoy!

 

 

 

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Do You Have a Support System?

This is a re-post that was originally posted in January 2017.  Enjoy!

Once upon a time I was given the gift of seeing a real-life support system in action.  I was invited, as one of a few non-Old Order Mennonite women, to attend a quilting bee. The room was very quiet as 16 women sat around a large quilt frame—each of us focused on the task at hand.

Breaking the silence, one of the women stated that a young woman in their community had recently given birth.  Another commented that the baby was unwell.  Over the next 20 minutes, these women quietly put a circle of care in place around this family.  Meal drop-offs were planned, house support was organized, child-care for the baby’s siblings was put into place, and daily check-ins were arranged.  These women activated a support system for this family as naturally and easily as they made the small stitches they were adding to the quilt.

I’ve thought about this experience often over the years as I’ve watched others struggle when there has not been a support system in place.  Independence is seen as such a positive attribute in our culture, but at what cost?  When we strive to do everything ourselves, we not only run the risk of being overwhelmed in times of need, but deprive ourselves of the joy that comes from supporting others and building community.

We may not live in an organized community, such as the Old Order Mennonites, but we do have relationships.

Levels of Relationship

While no two relationships are identical; I believe that they can be divided into the following four levels:

Level One relationships are those we share with casual acquaintances—a clerk in a store, our bank teller, the barista at the coffee shop on the corner.  The topics of conversation tend to be about light, surface topics such as ‘the weather’.

Level Two relationships are the ones that go deeper than those in Level One, with people we see more frequently.  One example may be with a co-worker—we would tell them that we’re going on vacation and give basic details—when, where, who with—but little else.

When we spend time with our friends, we are engaging in Level Three relationships.  Confidences are shared, we may see them often, and there is a comfort and familiarity.  To continue the vacation example—we would tell them why we’re going, what our dreams are for the trip, and send them personal updates during the adventure.

Level Four relationships are the ones that are rare.  The people who are at this level, are those that we can phone at any time of the day or night because we need them—either for help or to share good news.  We know that they have our backs and will always be there for us.  This is usually a reciprocal relationship.

Building a Support System

Building a support system requires a willingness to look up from our lives and notice those around us.  It requires the courage to be vulnerable and ask for help when we need it.  It requires the willingness to share our time and resources.  Being able to trade independence for interdependence—to not only give, but also to ask for help is crucial.

All levels of relationships are needed in a support system.  Simply listening to the elderly person standing in line with you at the grocery store as he talks about his grandchildren, is a way of being part of a support system.  You’ve never met him before and you may be the only person he talks to all day.   Noticing that your co-worker is looking tired and asking what’s going on is being part of a support system.  Telling your friends that you’re feeling overwhelmed and asking for help is being part of a support system.

As we take the time to do this, our relationships deepen (go from Levels 1 to 3 or 4), our community widens and our support system grows.  You can think of support systems as a group of concentric, interlocking circles.

Start Where You Are

Early on, when I work with clients as they cope with challenges, I ask them about their support systems.  Many will respond that they don’t have one.  For some, as we tease out their relationships, they are amazed that they have more supports than they thought—especially if they are willing to be vulnerable enough to ask for help.  For others, I’ve become their first support as we work on finding others that they can call on.

There are a multitude of groups (specific to various challenges) as well as crisis lines that can provide help and ongoing support when necessary.  A list of some helpful numbers is included in the resources section of this website.

Learning to ask for and give help is like building muscle.  The more we at it, the easier the process becomes.  Below is a TED Talk by Amanda Palmer who developed her ‘asking’ muscle in a very interesting way.  Enjoy!

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Goals…Are They a Good Thing?

Some of us love setting goals. We have a vision of where we want to be.  Then we create a plan of what we need to do in order to make our dreams a reality. Perhaps we use “To Do” lists, or track our progress on electronic devices–either way, we feel that we are working towards what we want.

Western culture, and it’s bias towards “doing” vs. “being”, elevates goals as a key component of attaining success.  We have self-improvement goals around fitness  and weight-loss.  There are work goals, relationship goals, company goals…the list goes on.  Do a search on Amazon.ca for goal resources and there books that tell you “How to Get Everything You Want–Faster Than You Ever Thought Possible”.  It’s not enough that we fulfill our plans, but now we must do it as fast as possible!

Questioning Goals

As a human, I’ve been goal-driven for a long time. As a therapist, I’m starting to question if this behaviour is a good idea. By I pondering the idea of goals, I’m starting to see that they may be a double-edged sword–if done well, they can be a useful tool for providing a framework for accomplishment.  However, they can also be an unforgiving taskmaster that gets in the way of enjoying life.

Are Goals a Good Thing?

There is little double that goals are a tool to help us get things done. Goals can keep us directed and focused on where we are going.  We experience the satisfaction that comes from crossing items off our “To Do” lists or noting that we have met our aspirations for the day or week.

However, I suggest that while goals can help us to be focused on where we want to be, they can lead us to become too focused.  When we have a narrow view of where we’re going, we can miss the wonder, magic and possibilities that are outside of our line of sight.  For example, if we see the only way to reach a fitness goal is by attending cross-fit classes, we lose out on the beauty and fitness opportunities provided by a hike in the woods.

What happens when we don’t reach a goal?  As we become attached to the outcome of our efforts, if things don’t work out as we expected we may feel guilty, or that we’ve failed. We become fixated on what we didn’t do, versus what we did accomplish.  Goals become a way to be unkind to ourselves.

The Story of Sylvia

Sylvia is a 35 year old woman who has decided that  it is time to regain her health and fitness levels that had declined due to the changes in lifestyle during and after two pregnancies.  Sylvia’s two children were born within 15 months of each other.  The short period between pregnancies left little time for her body to recover.  Now, three years later, Sylvia is struggling to lose the residual weight gain.  Her blood pressure is higher than recommended, and she is often winded when climbing stairs. Sylvia has decided to lose 30 lbs in three months, and get in better shape, by going to the gym and watching what she eats.

For the first week, Sylvia is highly motivated to reach her goal.  With Heather’s (her partner) support, she was able to go to the gym five times.  She created a meal plan and stuck to it.  She removed all the ‘junk’ food from the house and left fruit on the counter for snacks.  When Sylvia weighed herself at the end of the week, she was a little disappointed that she had “only” lost two pounds, but figured that it was better than gaining weight. She vowed to “do better” next week.

For the following two weeks, Sylvia kept to her schedule…though it was getting difficult.  She was losing her excitement faster than her extra weight.  Heather was starting to feel somewhat resentful of Sylvia’s time at the gym as it was taking away from family time.  It was difficult for the couple to keep up with the time needed for the healthy eating plan and both were starting to miss some of their favourite meals.

By the end of the fourth week, Sylvia had given up on her weight loss, fitness and health goals.  Both children had come down with colds and wanted more attention.  She had been to the gym only once, and when there felt too tired to do a complete workout.  They were sick of the strict whole foods diet, and had started ‘cheating’.  Sylvia had gained back two of the total five pounds she had lost since starting this process.  She felt frustrated, hopeless and resigned that she would be carrying around the extra weight for the rest of her life.  She was afraid that she would need to start taking blood pressure medications.

What if there had been another way for Sylvia to formulate her goals that would have been more helpful?  Enter SMART Goals!

SMART Goals

Goals are a tool, and like any tool they are most useful when we use them with skill.  The more thought we put in at the beginning when creating them, the better easier they will be to accomplish.  Used properly, they are no-longer a double-edged sword.

SMART goals are specific, measurable, agreed upon, realistic and time-based.

Let’s look at how Sylvia’s goals would have changed if she had used this method.

Specific:  Part of Sylvia’s goal was specific (lose 30 lbs.); however, what did she mean when she wanted to “get in better shape”?  Would she be able to do 50 squats in one minute?  Ride her bike up a steep hill without stopping?  Run up a flight of stairs?  Did she know her ideal blood pressure score?

Measurable:  A goal is measurable when you are able to determine where you are in meeting the goal.  In Sylvia’s case, it means not only answering the question of how she will know when she has reached it, but also creating signposts along the way.  For example, if Sylvia wants to lose 30 lbs. in three months, that means she would need to lose 10 lbs/month or 2.5 lbs/week.  She can measure her progress along the way.  Perhaps she can check her blood pressure on a monthly basis by visiting her local pharmacy.

Realistic:  In order to avoid frustration and discouragement, it’s very important that goals are realistic.  How realistic was it for Sylvia to lose 2.5 lbs/week?  Is this healthy?  How much work and commitment to exercise would it take to accomplish this part of the goal?

Determining if our goals are realistic often requires knowing ourselves (what we’re truly capable of), and finding out how much support we have from others (Heather is willing and able to support four gym trips a week, but feels that five is getting in the way of family life).  We may need to do some research to learn what others have been able to accomplish under similar circumstances.

Time-based:  Having ideas of timing are important.  When we know our timing, it makes the goals more concrete.  It’s the difference between saying I want to learn to cook Indian food sometime in the future and I’m going to learn to cook vegetable curry by the end of next month.  The months can fly by and we’re no closer to serving homemade curry to our friends!

Sylvia set a time limit of three months.  Based on all that she has learned by looking at the other areas of SMART goals, is this still possible?  As the creator of the goals, she can decide.

Goals in Therapy

When I start working with a new client(s), I ask them how they would like things to be different when they are finished therapy.  By answering this question, we are starting to to think about therapy goals.  Depending on the individual client(s) situation, creating SMART goals may then become part of the therapy process.

In the end, if used wisely, goals can be a tool that can help you to reach where you would like to be.

And now for something completely different.  Goals come in all shapes and sizes!  Enjoy?!

 

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