Category Archives: Self-Care

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 (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 ).

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.

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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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 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!


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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What’s “The Point”?

In the early 80’s I was introduced to the 1971 album “The Point” written and narrated by Harry Nilsson. An animated version was released shortly afterwards.  This musical (one of my favourites) is the tale of a boy named Oblio–the only person in the Land of Point without a point, and therefore, ‘different’.

This story is suitable for adults and children alike…with a message that still has a “point” over 45 years later.

For the last long weekend of the summer, take some time to relax and enjoy…. Continue reading What’s “The Point”?

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Staring Into the Distance

When you recover or discover something that nourishes your soul and brings joy, care enough about yourself to make room for it in your life. – Jean Shinoda Bolen

We all take care of ourselves in different ways, and taking a break from our usual routines is often a method of choice.  Moving away from our daily grind can provide perspective on where we are in our lives.  Being in nature often puts our concerns into a bigger framework. For me, staring across a large body of water allows me to ask myself some bigger questions…Where am I now?  Where do I want to be?  What’s important at this time in my life? What can I let go of?

As the long weekend approaches, I invite you to spend some time ‘staring into the distance’.

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The Art of Self-care or How Full is Your Cookie Jar?

When meeting with new clients, one of the first things we talk about is support systems. Do they have one?  Does it include a self-care plan?  Do they feel that they deserve to take care of themselves?

When thinking about self-care, I’m thinking about the things that we do that help us to stay grounded, healthy and happy. These activities are as unique as there are individuals.  For some people it’s a daily yoga practice or monthly massage. For others, it’s spending time reading a book, strenuous exercise, going to bed early or walking their dog.  The specific actions aren’t important, it’s the fact that they ‘feed you’ in a positive way.

The Importance of Self-Care

Life is stressful. We’re often pulled in many directions at the same time.  For some of us, days are spent trying to balance our children, partner, career responsibilities, elderly parents, volunteer commitments, social calendars…the list goes on and on…and in many different configurations.  Add to that the little voice that tells us we should be taking care of ourselves as well, and we’re overloaded.  Self-care becomes the last thing on our ‘To Do’ list.

However, if you are in doubt of the benefits of allowing time for self-care, I suggest reading When the Body Says No:  Exploring the Stress-Disease Connection by Dr. Gabor Maté. Through research and case studies from his own clients, Dr. Maté examines the link between diseases such as ALS, cancer, rheumatoid arthritis and others, and the lack of self-care.   The interesting thing is that Dr. Maté pushes the boundaries of self-care from the basics of yoga and adequate sleep to the emotional realm, by including the concept of Emotional Competence.

What is Emotional Competence?

Simply put, emotional competence is our ability to take care of ourselves by removing ourselves from stressful situations.  This is a skill that is ideally learned in childhood, when we are given the support and acceptance by our caregivers needed to develop our ability to self-regulate (i.e. deal appropriately with) our feelings and desires.

According to Dr. Maté, emotional competence involves:

  • the capacity to feel our emotions, so that we are aware of when we are experiencing stress;
  • the ability to express our emotions effectively and thereby assert our needs and to maintain the integrity of our emotional boundaries;
  • the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past.  What we want and demand from the world needs to conform to our present needs, not to unconscious, unsatisfied needs from childhood.  If distinctions between past and present blur, we will perceive loss or the threat of loss where none exists; and
  • the awareness of those genuine needs that do require satisfaction, rather than their repression for the sake of gaining the acceptance or approval of others. (pg. 38).

In other words, we need to know what we feel, discern what we need, and then have the confidence to ask for, and accept, help.  This is the ultimate in self-care.  However, this is often very difficult to do.

The Enemy of Self Care–Is Selfishness a Bad Thing?

Despite the zeitgeist of individuality that defines our current North American culture, selfishness is seen as a bad thing.  Especially for women, there is an expectation that care-giving is the ultimate (and often thankless) role.  For many people, especially if care-giving is the way they learned to adapt to problems in their family of origin (i.e. original family), being considered selfish is a massive insult.  When chronic care-giving is the water we swim in–we would rather be thought of as anything but selfish.

Perhaps we need to look at selfishness from another angle?  Who is calling us selfish?  The people who directly benefit from our lack of willingness to say no?  If we decline to help out at the local garage sale, and instead choose to go for a walk in nature that day, what is the effect on the garage sale organizers?  Is that truly our problem? Do we feel guilty? Should we?

I’m suggesting that, in the grand picture of things, selfishness is actually a benefit for all concerned.  When we take care of ourselves, we are better able to help others.  Cookies anyone?

The Cookie Jar Analogy

Because of messages received in the past, we sometimes have a hard time justifying self-care.  I’ve found a useful way to describe this concept is the idea of a cookie jar.  If you imagine that each time you do something to take care of yourself, you get to put a cookie in the jar.  Go to the gym…put in a cookie.  Have a candle-lit bubble bath…there’s another cookie.  You get the idea.

Now, every time you do something for others, remove a cookie.  Take an elderly parent grocery shopping…there goes a cookie.  Help a child with homework…one less cookie. Particularly difficult tasks may cost multiple cookies. If you follow this game to its conclusion, it becomes obvious that if you don’t keep adding cookies to the jar, it will soon be empty.  An empty jar equals high stress and potentially burnout and/or illness.

It’s important for each of us to figure out what the minimum number of cookies that need to be in the jar in order for us to function for ourselves and others.  If the number goes below that amount, it’s time to start saying “no” and take action to add more cookies.

The Number 5 Rule

I once had a very wise clinical supervisor who at the beginning of each supervision session would ask me to state how I was feeling (emotionally, physically, spiritually) on the scale of 1-10.  She felt that if anyone was operating below a ‘5’ they shouldn’t be providing support to anyone else.  Years later, I still use this rule and check in before any type of care-giving activity.  Do I pick up the phone when I know it will be a difficult call?  What’s my number?  Do I agree to help with something outside of my comfort zone?  What’s my number?

I recognize that sometimes we have to ignore the ‘5’ rule–especially if it’s a matter of life and death or some other type of emergency.  Luckily, these are few and far between.

This is another form of self-care.

Self-Care and Therapy

For some people, seeing a therapist is a form of self-care.  A friend of mine once said, when describing her enjoyment of therapy:  “Where else do you get to talk about yourself for an hour and have someone listen with undivided attention?”.  Unfortunately, many people don’t come until they are in crisis.

Individuals, couples and families visit a therapist for many different reasons.  Self-care is a touchstone in each case.  I often complete a genogram (a specific type of family tree) with clients as a way to determine the main family players.  We look at relationships between members and their resulting roles.  Often we discover patterns that flow from one generation to the next, and chronic care-giving can be one of them.

The realization of chronic care-giving creates an opportunity to explore the feelings, history and beliefs that led to this behaviour as well as discussions about self-care. It’s amazing how many people don’t feel that they are worthy of care, yet feel that others are–even at a risk to themselves!

There seem to be days to celebrate everything–Canada’s Agriculture Day (February 16), Kool-Aid Day (August 12) and National Raisin Bread Month (November) to name a few. Self-care is no different.  In Britain, November 13-17, 2017 is National Self-care Week. This is an initiative by the National Health Service.  Why not create your own personal Self-care Week?  What would that look like?

Now, for a dollop of self-care, here’s some advice from the Sound of Music…enjoy!

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