| I recently came across a term I hadn't heard before, "crisis fatigue" Crisis fatigue occurs when our ability to be resilient (or "bounce back") is flooded with an ongoing series of intense, energy-consuming or traumatic experiences. As best as I can tell, it's a form of burnout. Crisis fatigue, like burnout, is a response to ongoing and intense stress, like that faced by people trying to survive war or armed conflict, economic or financially stressful conditions, political instability, natural disasters, or - yes - a pandemic. Based on what I'm hearing from my colleagues and patients, many of us are facing crisis fatigue. |  Photo Credit: Nataliya Vaitkevich, from: https://www.pexels.com/photo/matchsticks-on-pink-surface-6837623/ |
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 For the past two years, I've been working in nursing homes, offering counseling to seniors dealing with adjustment issues, depression, anxiety and a host of other mental health concerns. During that time, I've learned that there are people who are polite, and people who are just flat-out mean. I recently had the pleasure of trying to interview a gentleman who could not get over the idea that I was fat, and was very obnoxious about it. Factually, he is right - I am fat. I'm not upset about that - it's the judgment and cruelty in deciding that I am less of a human being because of it that was hurtful.
We'll call him "Mr. Jones" for simplicity. When I went into Mr. Jones' room to introduce myself, he immediately said, "Well, you've put on weight, haven't you?" Not hello, not "how are you," - just an immediate comment on my body. I ignored it and introduced myself and told him I was here to talk with him. He, however, could not get past my appearance. I went to sit down, and he said, "You can't sit on the furniture. You'll break it." I let him know, gently and politely, that I had been sitting on the furniture for over two years without a problem, and that I had a job to do. He said, "you're too fat." At that point, even my patience was shot. I said, "Mr. Jones, I am here as a professional and your comments are out of line. My body is not under discussion. I'll come back again on Friday, and maybe we can try this again." In my work, one of the hardest things I face is letting a client know that it’s time move on. There are many reasons for ending therapy, and I’m going to explain some of them so you can see how complex the decision can be. I’ll start with a couple of reasons why clients end therapy.  Have you ever noticed how something small can be a "tipping point" that changes your day from "good" to "bad" in an instant? It can be a critical comment from someone at work, or a family member saying or doing something that makes you pause and think, "Wow...that was out of line." It can be something impersonal, like getting flipped off or cut off in traffic because someone else is in a hurry and not driving carefully...there are any number of things that can really mess up our day, and leave us feeling drained, irritated and/or angry, and feeling like everything's going downhill.
Frankly, it sucks. We've all been there, and know what it's like. I'm not going to lie and say I never get stuck in it. It's easy to let things add up and take over, and may feel like we're riding a wild, out-of-control, roller coaster. So, what do you do? Well...as usual, there are some answers and tips from the therapeutic couch that may help. These aren't necessarily the only things you can do, or "THE ULTIMATE COSMIC ANSWER" - rather, they're things you can try to help YOU feel better. Unfortunately, there's no magic wand to change the world around you, and we can't make your husband/kid/boss/coworker/"idiot on the road" change. That's just beyond our control. (In therapy I sometimes take a kid's pretend magic want, whap it on the table or chair and say, "See? It's broken - it doesn't work! NOW what do we do?") Well...now what do we do? The first thing, in my experience, is to try and separate yourself from what's going on. You can't make your boss be nice, or make that person on the road or in the grocery store be polite and reasonable. You can't make your family members stop making comments about your appearance. However, you can set up some good boundaries and realize that you don't have to allow them to get you upset. I'll fully admit, though - some situations are easier to do this with than are others. Easier said than done, isn't it? Trust me, I know - from tons of personal experience myself. And yet, it's important to know what's your stuff and what's their stuff. (Remember the definition of a boundary? It's where you end and I begin.) Eastern faith traditions call this compassionate detachment - you can look at what's going on and realize (or even say to yourself) that "this is what's going on for him or her. If I have something to apologize for, I can do it. But their anger or their irritation is NOT me." It sounds a little weird, I'll admit. And it does take practice to become a habit. But if you think about it, it's incredibly freeing to realize that you're not responsible for someone else's anger, or even their feelings in general. Now, don't get me wrong - certainly what we say or do affects the way other people feel - this isn't a "get out of jail free" card to say or do whatever you want. In fact, our actions can be the tipping point for someone else - so it pays to watch what you say and do as well. Anyway - realizing that you are separate from someone else's emotional reaction can help you deal with what's going on in a more rational "wise mind" kind of way. (If you don't know what "wise mind" is, see the post for DBT Skills, Part 1 ) So, knowing what's you and what isn't you helps. Another trick from the DBT bag is to try "opposite action" - this is where you do the exact opposite of what you want to do (part of the DBT Emotion Regulation skills). I know...it sounds hard, and it is. When you want to spit back a sarcastic response, you instead say something nice. "Thanks for your input. I hope you have a great day from here on." It might be the last thing in the world that you want to do - and it does help. You'll have to trust me on this one - but think of it this way - if nothing else, it confuses the heck out of the other person! Another thing to do is just take a quick breathing break - practice distress tolerance skills (another DBT post: Distress Tolerance Skills) or relaxation and stress reduction skills: breathing, distracting yourself, self-soothing (a coffee or tea break can work wonders), a little bit of exercise (say a walk at lunch), or anything that helps you feel better (and doesn't harm anyone - including the person who ticked you off to start with ;p ). All these things can help. Finally - all the CBT stuff I talked about earlier will also help. These may not completely turn around your day, but they can help you feel better. The key point is to remember that you don't have to let someone else's bad mood or bad day ruin yours. So...have a great day, and remember that someone out here is rooting for you! Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral. If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com "Oh, you want me to organize the next women's group? Well, I've got a lot on my plate, but if you really want me to, I guess I could do that..."
"Ok, I'll get this report done by the end of the day..." (followed by getting caught up in other tasks, conversations, etc.)..."I'm so sorry, things just got out of hand. I'll just try again tomorrow; I might be able to get to it then." "I'm so tired. But if you need this right away, I guess I can get it done." Do any of these situations sound familiar? One of the workshops I offer teaches assertiveness skills. I'll admit something to you here: Being assertive is something I still work on, and probably will be working on for a while. So let's start at basics: What is assertiveness? Assertiveness is first of all a way of communicating. It's worth discussing what assertiveness is not as part of this definition: it's not aggressive, disrespectful, or mean - it's not looking for a fight. Assertiveness is also not passive or passive aggressive - it's not doing things behind someone's back even if you think you're right, it's not giving in or letting someone run roughshod all over you. It's not a tactic for getting your own, way, either. In both of these methods, you have trouble saying "no" or maintaining and respecting boundaries (your own, or someone else's). I've talked about saying no and boundaries in other posts, so I won't spend a whole lot of time on these, other than to say that assertiveness is more than these two important factors. These are also skills that are used in DBT, in the Interpersonal Effectiveness module. Ok, so what IS assertiveness then? As I mentioned, it's a style of communication. Here's a quote from a workbook I use (and draw upon heavily): ...it recognizes that you are in charge of your behavior and that you decide what you will and will not do. Similarly, the assertive style involves recognizing that other people are in charge of their own behavior and does not attempt to take that control from them. When we behave assertively, we are able to acknowledge our own thoughts and wishes honestly, without the expectation that others will automatically give in to us. We express respect for the feelings and opinions of others without necessarily adopting their opinions or doing what they expect or demand" (Paterson, 2000, p. 19). The bottom line is that being assertive means being respectful of ourselves and of others. It means being aware of what we want and need, and working to meet those needs in honest, open, and respectful ways, and respecting other people as they try to do the same. Learning to say and hear "no" and developing, maintaining and respecting healthy boundaries are techniques used in assertiveness - they are part of it, but not the whole. Here's some examples of an assertive statements: "I can't join this committee now. I'm on two other committees and I need to have some 'down time' to take care of myself." "I just bought this book yesterday, and I noticed today that there is a page missing. I'd like a replacement, please." "Excuse me, I'm next in line." So, what gets in the way of being assertive? Lots of things. Again, drawing heavily from Paterson's book, our own fears, the reactions of others to us being assertive, power differences in relationships (e.g., employer/employee, doctor/patient, parent/child, man/woman - I'll address the gender thing in a bit), stress (this is hard work!), our own beliefs about what being assertive means. Stress reactions can be calmed with stress reduction and relaxation techniques. I don't want to minimize the importance of these, but they are a different set of skills and can be covered in a different post. The other stuff leads up to the stress component, so let's focus on those things. Our own fears and beliefs about assertiveness get in the way for several reasons. First, we may worry that we'll offend someone, or that they'll be angry at us. And the reality is, that may be true. Let's go back to our working definition of what assertiveness is, though - they are responsible for their emotions, reactions, and behavior. Your job is to take care of yourself, in a way that's respectful - and that means respectful of yourself as much as anything. Dealing with someone else's anger is tough, I'll admit. (When you're in a relationship where abuse is possible, it can be downright dangerous, and this is where you want to have support - people you trust and that can help, a place to go if you need it, and a safety plan. This post isn't meant to address abuse situations.) Anger comes up a lot when you're changing your style of interacting - if you've always been passive before, seeing you change may be a shock to the people who are used to having their own way. And you know what? They'll adjust. Your fear, though, can get in the way. So what do you do? Well, imagine you're a coach - what would you tell your client or athlete? First of all, ask yourself what you're afraid of? What is the worst that can happen? Are your fears realistic? If so, how can you help yourself, respect yourself and still be assertive? (Tough question, I know!) Second, try it out. See what happens - you may be surprised. Maybe you can find a less stressful or lower intensity situation in which to practice. Success is the best reinforcer here; if you succeed and have a good experience you'll be more likely to do it again. As the title of one book says, "Feel the fear and do it anyway." Here's the thing - if our fears get in the way, we tend to act out of our fears rather than acting out of the need to respect and meet our needs. The result is, we don't get our needs met. Your other beliefs about assertiveness can get in the way as well. Do you belief that being assertive is unladylike or bitchy? Do you believe that it's selfish, or that other people's needs come first? These are all things that women who are assertive face in this society, by the way - there's that gender thing. Do you think it's impolite to disagree or say "no"? Many of us were raised to disrespect our own needs and focus on others. Being assertive after all this training otherwise is hard. Examine these, and look at how these beliefs affect your behavior. Then try an experiment - just try, once, to contradict one of these and be assertive anyway. See what happens. Ok - now what about how everyone else reacts? Well, we've already noticed that other people may react by being angry, offended, or puzzled by your new assertiveness. This is where your boundaries become important. Don't back down, but don't get aggressive either. It's important to keep and maintain those boundaries. Here's a good rubric for being assertive:
As Always: Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral. If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com References: Paterson, R.J. (2000). The Assertiveness Workbook. Oakland, CA: New Harbinger. Stephen Ministry Leader's Training Manual. (2000). T-6, Assertiveness: Relating Gently and Firmly. St. Louis, MO: Stephen Ministries. "No" is one of the first words we learn to speak, and it's loaded with a lot of emotional baggage. When we first learn to say "no" as a toddler, we have likely heard it enough times that we know what it means, and it's a first expression of our individuality and independence. We learn that "no" means stop doing something, it means we can't have what what we want, and it means annoyance, disappointment and sometimes, hurt. However, we also learn to say "no."
As we get older, though, saying "no" gets harder. We learn pretty quickly that saying "no" to Mama and Daddy doesn't work too well. Saying "no" to teachers doesn't work at ALL well. We hear "no" more often too. Women especially learn that saying "no" is harder because we're expected to be nurturing, kind, caring - all those things that fly in the face of an honest and sometimes appropriate "no." Dealing with "no" and setting/maintaining healthy boundaries is a big part of CBT, DBT, and Assertiveness Training Skills - with good reason. Many of us don't learn what good boundaries are and have little to no idea of how to set and maintain our own, or how to deal with others' boundaries. Saying and receiving an appropriate "no" is a boundary issue and something that we have to learn to deal with everyday in a multitude of situations. For example, I recently learned that I did not get a job I for which I'd hoped to hired. This was a clear "no." Whether it was appropriate or not (my opinion certainly differs from the hiring committee!) isn't the issue here - the issue is how I deal with hearing "no." I won't lie and say I wasn't disappointed, but I'm also not getting into a death-spiral-funk about it either. My boundaries and sense of self are intact enough that I don't take this as a reflection on me as a person. And that is the trouble with hearing "no." Often, we take it as meaning that we are not good enough or right enough when we hear it. Like children, "no" may mean not getting what we want and we equate it with "no, you're not worthy of/good enough for __________ (fill in the blank)." It may feel like a personal attack, or that the person saying "no" doesn't love us enough, want us enough, or care about us enough. Hearing "no," though, really doesn't mean that it's a reflection on who we are - it simply means that the person saying "no" simply can't or won't meet our need at that time. The reason doesn't matter, what matters is how we deal with "no." Honestly, there are a lot of ways we can do this. We can do the emotional equivalent of having a temper tantrum and yell, insult, or fight with the person saying "no." (You see this all the time in comments sections under articles or stories on the net.) We can turn the cold shoulder and freeze the person out. We can try and try to change their mind, even when it's a clear "no." However, all of these methods are boundary violations - we are violating the boundaries of the person who said "no." So how DO you deal with it? First, recognize that it's not a reflection of your value as a person or your value to the person saying "no." That's a hard pill to swallow, I know - many of us learn through life experience that our value to others depends on pleasing them, and we alternate between trying to do that and rebelling against that internalized message. The idea here is "no" simply means "no" and that it doesn't mean we're bad people or that the other person doesn't care about us. Next, ask yourself how you would want the other person to act if you had to say "no" to them. (I know - I can hear a lot of you saying, "but I wouldn't say "no" to them!" Just go with me on this, ok? :) ) Would you want them to scream, cry, threaten you, insult you, try to change your mind? Somehow, I don't think so. This is where the "golden rule" really has value - treat them the way you'd want to be treated. Also, if you have to vent - if you think the "no" was unfair, was mean, etc - vent in your journal or to someone else. Venting is not a bad thing; you just want to use it appropriately. Venting at the person saying "no" isn't going to help and may in fact damage your relationship with the person beyond repair. So think about how you want to react to them, and where you REALLY want to vent - and then do it in a way that is safe and respectful. Respecting the other person's boundaries is something we all have to learn to do. So, what if you need to say "no"? Well, again the golden rule applies: we don't want to be mean, sarcastic, threatening or insulting. The goal here is to first respect our own boundaries and then be respectful of the other person's. Assertiveness training and skills come in handy here, but generally a kind but firm "no" is all it takes. You don't have to explain it (you can if you want), and you don't have to change your mind, even if the other person doesn't respect your boundaries. You can use what is called the "broken record" technique if you need to. "I'm really busy that day and can't drive you to the picnic." "I'm really busy that day and can't drive you to the picnic," etc. If the other person is not respectful of your "no," you have the right to remove yourself from the situation or to be firm and clear about your "no." You don't have to be angry or threating in your tone of voice (although you may feel justifiably irritated and annoyed!). Women especially have a hard time saying "no" appropriately because we've been socialized to be the nurturers and caregivers. Saying "no" contradicts the "take care of everyone else before you take care of yourself" mantra that is the undercurrent around traditional women's roles. Saying "no" is an important skill. So here's an idea for you: Keep track of how many times someone says "no" to you and to how you react. Also, keep track of how many times you wanted to say "no" and didn't, and how you felt about yourself and the other person. Finally, keep track of how you did say "no" to others, and how you felt. It's an interesting exercise and very eye-opening. Even simply paying attention to the pattern can help you see and work on appropriate boundaries. And that, my friends, is a very good thing. As Always: Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral. If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com. You may also call me at (970) 776-6043 for information. |
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