Category: CBT

Assertiveness: An Introduction

7/13/2014

"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:

Decide whether to be assertive
Decide what to say
Decide what to do
Assess the results:

Ok, believe it or not, this is just a little part of the workshop. (It's a long post, I know).

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: [email protected]

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.

0 Comments

Dealing With Trauma - Coping

4/28/2014

0 Comments

Due to the length of this post, I am dividing it into two sections for readability. If you have any comments or questions, please feel free to contact me: [email protected].

During my training, I developed an analogy I'm going to share with you here. Using medication and therapy together is like working to fix a house with a crack in the foundation. The first thing you have to do before you fix the crack is shore up the house, right? Using medication is like shoring up yourself - it takes care of the biological and chemical aspects of what is going on. One thing I want to emphasize - these medications are not addictive! They help stabilize you and bring you up to feeling normal, NOT feeling "high." From there, you work to fix the crack in the house - this is where the therapy piece comes in. If you try to fix the house by shortcutting either one of these steps, guess what? The foundation is going to stay cracked, get worse, or possibly break again. Using both tools (medication and therapy) will help you heal the foundation and make your house - you - stronger by helping you learn to recognize problems and deal with them in a way that keeps you healthy and whole.

With these things in mind, there are things you can do to help yourself as well. Among those things are some of the techniques I mentioned earlier in the "Coping with tough times" posts. The difference here is that there is a slightly different focus. When you are dealing with recovery from trauma and/or PTSD, anxiety and fear are huge issues that don't simply "go away." When you're working with anxiety, self-soothing to reduce the anxiety, worry and fear that you feel is crucial. So, the same things I mentioned before: listening to relaxing music, meditating, journaling - whatever you find soothing and helpful that does NOT become hurtful - will help some.

The cognitive - or "thought" - piece that's different is that you want to recognize and acknowledge the emotion specifically related to the trauma or experience - "Ok, I'm really anxious and feel like I'm coming apart at the seams. What is behind this anxiety? Am I afraid that <insert whatever traumatized you> will happen again?" If that is the case, asking yourself, "how likely is it that it really will happen again?" may help. In some case, the likelihood might be high - you'll want to work on what you can do to protect and shelter yourself if that's the case, and working with professionals in many fields (police, medical, psychological) may be part of that process. In other cases, the likelihood of the event reoccuring may be low - in that case, reassuring yourself that you're safe, that you're doing everything you can to keep yourself safe may also help. Please - again realize that you don't have to do this alone. The support you'll receive from a good therapist can really help you feel better.

Another area in which you may want to work involves your boundaries. Especially for those of you who were victims of abuse, rape or other traumas where your physical and emotional boundaries were violated, setting and maintaining healthy boundaries is crucially important AND very hard work. For those of you who are in situations where your boundaries are still being violated, setting and maintaining healthy boundaries may threaten the person violating them - for you, I would strongly recommend seeking the support of a professional in working on these issues, creating a safety plan, and having an escape ready if necessary. You will need support and possibly protection, and working with a professional - whether it's a medical doctor, psychologist, therapist, or clergy - will help you get the physical and mental protection and support that you need. Do not hesitate to call 911 if you need help!

Learning to set boundaries takes practice and work. I've done completely separate posts on working on boundary issues, but for now, let's first discuss what boundaries ARE. The basic idea here is that a boundary is something that separates you from everything else. Your skin is a boundary between your insides and the outside world, and protects you from injury. Likewise, psychological boundaries are the ways that you know you are separate from everyone else around you. To quote the title of a popular book on boundaries, they are "where you end, and I begin." ("Boundaries: Where You End and I Begin" Anne Katherine). Another book described boundaries this way: "They define what is me, and what is not me" ("Boundaries" Henry Cloud & John Townsend). When your boundaries are violated, you are being told "it doesn't matter who you are, what you want, or what you need. What I need or want is what counts, and I'm going to take it whether you agree or not or whether you say no or not." For many of us who have experienced trauma, our boundaries have been severely violated and compromised; this leads to a sense of helplessness, fear, anxiety and/or depression. The best thing you can do at this point is first realize that your boundaries have been violated (and that you have a right to even HAVE boundaries), and from there, work on realizing what they are and how to set and maintain them. This, as I know from experience, is hard work.

Working on boundaries though, also helps you work on and deal with trauma. By building boundaries, you are saying that you have the right to be whole, the right to control who and what has access to your body, your thoughts, and your feelings. Dealing with trauma also involves understanding and working with your feelings. Emotions can be very frightening and very threatening sometimes, especially if they are powerful or intense, like anger/rage, depression, or anxiety. It may feel like they are going to engulf you, drown you, and/or never end. This is where envisioning the emotion as a wave can be helpful (see the previous post for more information.) If you feel you can't stand it, that you are going to do something harmful like cut yourself, hurt yourself or someone else - get help - call 911. If you're not to that point - do something that will help yourself - call a friend (or sponsor if you're in a 12-step program), distract yourself if it helps, write it out, something that will help you. The thing is, the emotion WILL pass, and you WILL survive it.

In "dialectical behavior therapy" - one of my areas of expertise - we teach people some skills for "emotional regulation" and "distress tolerance." These skills help people deal with the overwhelming sensations that their emotions are going to engulf them. What I've described for you in the coping skills post are some of those skills. I will write more about DBT in coming posts, as it is a very helpful system for dealing with trauma, emotional storms, and coping in general.

Trauma is also isolating - we may feel that we're all alone in this, or that we'll be punished or embarrassed if we talk - a common phrase I've heard is "we don't air our dirty laundry to others." The thing is, the "dirty laundry" that is being aired is often the very stuff that is traumatizing. Opening up - say, in the context of a trusted relationship or a support group, can be the most healthy thing you can do - you'll find out you're not alone, and that other people have experienced similar things. You may feel like you don't belong, or that you're alone, or that you're somehow "damaged" - being with other people who have experienced similar things or with someone you trust can help you see that you're not damaged and not alone.

The final thing I want to say at this point, is have a safe space. Someplace where you CAN relax - at least a little - and feel safe just being and healing. This might be your bedroom, a special spot in nature, going to your place of worship, or even just creating a safe spot in your mind, wherever you happen to be. While you're in this safe space, breathe slowly and deeply. This is part of learning to soothe yourself, and is part of healing. If you experience triggers related to your trauma, get help if you need it - take care of yourself! If you don't need immediate help, do what it takes to get through it.

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.

0 Comments

Coping With Tough Times, Part 2: Coping Skills

4/28/2014

0 Comments

Ok, so what do you DO if things are still tough? "Tough Times" can be found in relationships, financial troubles, work situations, family issues - a whole range of things. What's "tough" for you, may not be tough for someone else, and what's tough for them might not be for you. So, given that these things are different for different people, what are some things that pretty much everyone can use? First of all:

If you have been feeling down for two weeks pretty much every day and for most of the day, if you have thoughts of hurting yourself and/or others, or if you're having trouble functioning, please see your doctor right away - you may be dealing with clinical depression. If you are feeling that you might hurt yourself or someone else, please call 911. Please also realize that seeking help really is a sign of strength and belief in yourself and not a sign of weakness.

As part of my training and my work with people in various situations in their lives, I learned a lot about coping skills - the fancy name for "learning to deal with it" - whatever "it" is. As you might imagine, this is a pretty important topic for therapists and their clients. And to be honest - I practice what I preach, and use these myself. There are a LOT of good self-help workbooks out there - I'll give a list at the end of this post - and these may help you structure your coping, if that's what you need. So - on to the meat of the post:

Let's start with things that end up being harmful. Basically it boils down to two things: Stuff that gets you in trouble, and stuff that ends up hurting you and/or someone else. Stuff that gets you in trouble includes excessive drinking, using mind-altering substances, excessive spending, sex, gambling, not fulfilling responsibilities like going to work, etc. Stuff that hurts you and/or someone else includes: excessive eating or undereating, exercising too much or not enough, losing your temper and abusing yourself or someone else, physically hurting yourself or someone else, beating yourself or someone else up emotionally, getting caught up in or laying on guilt trips, calling names, insulting yourself or others, and talking or thinking in absolutes (like, "I'll never be able to get out of this hole" or "You always ruin my day"). If you're feeling out of control with these things, please find help for them, if for no other reason than it helps yourself and your loved ones.

So what are the things that may help?

First of all - when you're feeling down or really anxious, realize that emotions are like waves - they build up, peak, and then pass. This idea is not new; Marsha Linehan's "dialectical behavior therapy" uses this concept. To cope with strong emotions that really feel like they're going to knock you down, it can sometimes help to remind yourself that the emotion will not last forever, and that it WILL pass. You are not your emotions - your feelings are reactions to things in your environment. Just as your situations change, so will your feelings. For me, I visualize an ocean wave as it builds, swells, and washes over me. You might like this, or maybe a gust of wind - whatever works. The point is, the feelings WILL pass.

Second, you can help the wave pass by distracting yourself. There are many things you can do - I work in my journal, create art, go for a walk, listen to calming music, surf the internet, etc. What you want to do is find something that will take your mind off the "down" feelings - it doesn't have to last forever, but distracting yourself will pay off, even if you only are able to distract for a few minutes. It's at least a few minutes that you weren't focusing on feeling "down" or anxious, right? There are an infinite number of ways to distract yourself - just use your imagination and see what you can come up with (and yes, this in itself is a distraction!) However, be careful with distractions - don't let them turn into "target behaviors" (the things that get you in trouble or harm you or someone else.)

One thing is important if you're feeling "down" or super-anxious - do something positive for yourself every day, such as exercise, get involved in doing something you enjoy - a hobby or pastime - , enjoy some quiet time to yourself, etc. Treating yourself as you want other people to treat you (a twist on the golden rule) or as you would treat other people is very important - you really are worth the effort and deserve to be treated well.

Third, try reframing your thoughts. This is admittedly sometimes a tough thing to do, especially when things feel hopeless or that a situation will never change or end. Sometimes working on changing your thoughts is a conscious effort; if you keep at it, hopefully the positive thinking will feel more natural. If you're having a tough time doing this, try writing down all the negative things you tell yourself and then contradicting them. Here's an example: With my work life, I admit to feeling like sometimes I'm spinning my wheels and not getting anywhere. I remind myself of what I've done (developed a private practice and found work with an amazing group of women at Beyond the Mirror), what I've achieved (my Ph.D., passed my licensing exam), and where I realistically am at (working on new content, expanding into new areas like life coaching, and applying my passions to my work) Reminding myself of the postives can help contradict the negative feelings.

Many therapists recommend keeping a "mood diary" or "thought record" where you can keep track of the thoughts you have, the feelings associated with them, how you changed your thinking, and what the result of the change was. Again, if this works for you - if you need and/or want to see your progress - by all means do it. It can be very simple - a piece of notebook paper divided into four or five columns (if you want to include the dates), and simply keeping track. It can be more complex, for example setting up an Excel spreadsheet. Keep in mind that first, the very act of doing this at all is a distraction (being busy tends to distract us from our feelings) and second of all, productive because you're working on helping yourself.

Mary Ellen Copeland, a therapist who deals with bipolar disorder, has developed some excellent tools for dealing with stress. She recommends creating a "wellness action plan" that includes 5 distinct parts:

1) Developing a wellness toolbox (similar to the coping skills described above) and keeping track of your moods and activities on a daily basis (the "Daily Maintenance List")

2) Listing the things that trigger feeling rotten and planning on ways to deal with those

3) Listing the "Early Warning Signs" of impending mood changes, and planning on ways to cut off mood changes BEFORE they get too bad

4) What to do when things are breaking down - how to deal with crisis situations: what the signs of this are, who to call/contact in case of an emergency, and how to deal with this when/if it happens

5) Developing a Crisis Plan: How to help other people know when you're in crisis, how other people can help you, and again who to contact

Copeland's web site: http://www.copelandcenter.com has some excellent information and resources related to this program. She also has several workbooks in publication and again, I'll list those here at the end.

There are also the things that we hear everyday from all kinds of experts: eat well and moderately, exercise regularly (this really DOES work to help moods, by the way), limit how much alcohol and other substances you put in your body, get enough rest and/or sleep, and see your physician if you're having problems in any of these areas to rule out physical/medical causes.

Specifically getting involved things that are designed to be relaxing may also help. Again, listening to calming or relaxation music may help. Other tools include meditation, relaxing tense muscles/progressive relaxation (for example, tense and then relax each muscle group in turn, starting at head and working down), using deep breathing from your tummy (diaphramatic breathing) - all of these things (and more) help ease stress and help you cope with feeling in the dumps.

The bottom line is that working to change your thoughts, helping yourself relax, and soothing yourself by doing things that make you feel better help you deal with feeling down. These aren't a be-all and end-all to always feeling down, or a sure-fire "cure" for the blues. They ARE things that may help, though, and are time-tested tools that have been shown to help.

If you have any questions or comments, please contact me here or via email: [email protected] . I'll be happy to talk to you and listen to your input.

Please Note: The information 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. If you wish to contact me, you can call (970) 776-6043 or send email to: [email protected]

Resources:

The Relaxation and Stress Reduction Workbook, 5th ed. - Martha Davis, Elizabeth Robbins Eshelman, & Matthew McKay

The Depression Workbook, 2nd ed. - Mary Ellen Copeland

Mind Over Mood - Dennis Greenberger & Christine A. Padewsky

0 Comments

Trust the Process

4/14/2014

0 Comments

In my work as a therapist, I practice a form of therapy called Dialectical Behavior Therapy, or DBT. I like it because it brings in awareness and mindfulness of the present as well as working on behavioral options. I find that there are generally two ways we can work with people. One is to be results-oriented - and in a therapy environment, this is not necessarily a bad thing. We - my clients and myself - want to see that the therapy we're doing is working, right? Makes sense.

The other way we work is being process-oriented. A process orientation involves more than looking for results - it's looking at what's going on between the two people in the room, in terms of how they're relating to each other, and how this relating reflects what's going on outside the therapy room for the client. It also means paying more attention to the deeper meaning of what clients say, and how their words reflect their emotions and experiences, as well as their growth.

Process is even more than that, though. Process is the flow of life that runs through us and with us and by us. How we react to life often reflects the process we're experiencing. Trusting the process means letting go of the illusion of control that's keeping us from growing and trusting that our process - our lives - will eventually be ok.

Letting go in this way is a scary thing to do. It's something I learn and re-learn every day, and have to consciously practice - trusting the process is an active trust kind of thing for me.

I have several "mantras" I use to remind me to trust the process. One of my favorites is, "It is what it is." I usually follow that up with a question that gets at the heart of the issue: "Now, how do you want to deal with it?" or "What are my options?"

There are several situations where I'm currently using this process...and none of them are easy. I'm finding for me, though, that letting go and trusting the process at the very least brings me some peace of mind. I take care of what I need to take care of, and the rest will be what it will be.

To me, one key to being able to trust the process is using one of my DBT skills: Radical Acceptance. The basic idea is that you realize that you first have to see what reality IS rather than what you want it to be, and then next, work on accepting that this reality exists. It's a tough process - but once you're there, you're better able to deal with what is, and won't get caught up on what should be, or what's not fair. Radical acceptance is key to learning to trust the process, because you can't begin to see the process until you accept the reality you're facing. It's that simple.

Another key piece is letting go. For me, this also takes conscious thought and action - I ask myself, "Ok, how important is this really? Am I going to be worrying about this, or be angry at this 10 years from now?" If the answer is no, it's probably a good thing for me to let go of. And I again struggle with this a lot - and am learning that the process is again, worth it.

So, trusting the process means first accepting reality for what it is, and then letting go of our expectations of what's fair or what "should be." What next?

Here's where it gets a little less behavioral...one of the things that DBT emphasizes is mindfulness, and I believe that mindfulness is another important key to trusting the process. Once we've accepted and have started letting go, mindfulness (being aware with compassionate nonjudgment) will allow us to be open to the possibilities and opportunities that DO exist. Mindfulness also allows us to be aware of what's going on around us, what triggers us, and what our choices are - it's an incredible tool for increasing awareness and connection, if we choose to use it that way - it's how we see the process part that's going on here.

The final key in trusting the process is simply, trust. Many have us have learned, and learned well that we can't trust anyone. Life has let us be hurt or injured maybe even by people who were supposed to love and protect us. Other people take advantage of us, or make fun of us, or generally make the world an unpleasant place in which to live. And here I'm telling you to trust. Yeah, right....

Here's where you use active trust (see earlier post). If you've learned to trust no one or anything, it may be time to try and see if the time is right to experiment a little with trust. To trust the process though, at some point, you have to take that leap and just let go and trust. Something, someone, sometime...Use your active trust if it helps, and realize that it's likely going to be worth the effort.

Trust the process - and see where life takes you. Even if you trust no other process than the fact that the sun will rise the next day, it's a start - and a good one. You may find yourself going in a direction you'd never considered, or meeting people you'd never have known otherwise. Let go, let yourself have an adventure...and trust the process.

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: [email protected].

0 Comments

Forward>>

Assertiveness: An Introduction

Dealing With Trauma - Coping

Coping With Tough Times, Part 2: Coping Skills

Trust the Process

Laura Burlingame-Lee:

Archives

Categories