Let's be honest - No one wants a "new normal." I was working with the idea of "new normal" long before the pandemic hit, but since the beginning of the COVID pandemic, the idea of adjusting to a "new normal" has become more universal. Since I moved to Boise, I've been working with neurological injuries and conditions, and one important aspect of coming to terms with these conditions is adjusting to changes brought on by illness or injury. These injuries and conditions turn peoples' lives inside out and upside down, and adjusting to the changes is an ongoing process. No matter what caused the injury or condition, the adjustment process seems to have some stages in common, similar to a grief process. We are seeing a similar process in people who have survived COVID and societally in our cultural reaction to the pandemic. Photo by Kindel Media: https://www.pexels.com/photo/woman-in-white-v-neck-t-shirt-smiling-7298391/
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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.
Emotions are weird. They have a way of changing so fast we hardly know what hit us, and they can change our outlook on a situation, person or perception nearly as quickly. It helps to remember that as much as our emotions affect us, they do not define us. We are more than our emotions.
A few months ago, I struggled with this. I was feeling down - I was being impatient and it seemed like nothing was going right. Now, if you've been reading these blogs, you know as well as I do, that this is not the case. Red Flag #1 - feeling down about things does NOT mean that the feeling is reality. Ok, good enough - and I was still feeling lousy. So, I thought...if I were the client, what would I be doing in therapy? (Yeah, I know... I'm a therapy geek.) Most likely, I'd be looking at the situation and testing out whether my emotions were really reflecting reality, or whether they were masking reality. How do you do this? Marsha Linehan has a really cool tool that she uses in DBT called "chain analysis." You start with the event, behavior or situation that was the problem. In my case, I looked back to when I started feeling down, and the even had nothing to do with what seemed to be the situation. I was feeling lonely on the afternoon before, because I couldn't reach my family members to talk. That spiraled into feeling somewhat depressed. Specifically, I remember thinking, "I guess no one wants to talk to me. I might as well not exist." Red Flag #2: I was getting caught up in "Stinkin' Thinking." In doing a chain analysis, you identify the event/situation that started the problem, describe the event, including what you were feeling and/or thinking at the time or what you did as a result of what you felt, and then describe how intensely you behaved, thought, or felt. In my case, the loneliness, sense of failure and depression were pretty strong. I ended up thinking, "I"m never going to be able to do this. I might as well just quit." Red Flag #3 - Stinkin' Thinking again. The idea here is that you want to describe all this in as much detail as you possibly can. Here's a good litmus test: Could someone recreate *exactly* what you went through? If so, then you've done it. Next, you describe what led up to the feeling, thoughts, or behavior. In my case, not being able to talk to someone was the situation. This "precipitating event" (also called a "prompting event") is usually what we point to when we say that "such and such" caused the problem. From here, you do a detailed description of all the things that affected the situation - Linehan calls them "vulnerability factors." In my case, I was tired from not sleeping well, I still had an annoying cough from a cold and didn't feel well, I was stressed by all the details stemming from running a new business as well as being worried about several emotionally intense client situations. I was overwhelmed, tired and not feeling good. I was also feeling emotionally exhausted by family situations and childcare issues. Ok, here's where chain analysis gets tedious - you describle in minute, excruciatingly clear detail the chain of events - starting with the all the way at the beginning with precipitating event(s) and going all the way to the consequences. Ok - here goes: I called my mother and got her answering machine. I then called each of my sisters in turn and had the same result. I started feeling like I didn't matter. I called my husband, who was out at the park with our kids, and he didn't pick up. I started feeling depressed, and went to work on my task list for this week concerning my business and the paperwork I had to complete. Looking at the things I had to do, I felt overwhelmed and incompetent, and felt more depressed. I remember thinking, "Why bother?" and which led to a deeper negative mood. The consequences were that I was not present when my husband did come home and wanted to talk. Right then, I just wanted to be left alone to marinate in my own misery. At that point, I recognized what was going on, and took steps to counteract the mood. The last step in the process is to describe in detail a prevention strategy and what you are going to do to repair negative consequences that resulted from your behavior or mood. In my case, my prevention strategy was stay mindful of my moods and to write. Writing in my journal, for me, is a safe place to vent and analyze what's going on. When I write, I feel better and so that's a good strategy for me to use. I can also go for a walk, and/or do something artistic. I could take a bubble bath, or have a hot cup of tea. Those are all things that help me - developing a list of what helps you will help you have something to turn to when you get feeling low. Nurturing and caring for yourself really IS important and necessary. Luckily, the interpersonal consequences here were small. I went upstairs and apologized to my husband, and explained what was going on. I also told him that I needed some extra time to myself to write and sort out the depressed feelings. If you're interested in more information on doing a chain analysis, you can go to a great website called DBT Self Help (www.dbtselfhelp.com) to get an idea of what this might look like in therapy or in practice. This website has an incredible array of tools, worksheets, handouts and articles. Hope this helps - DBT helps with a lot of things - I highly recommend looking into it. Even if you don't go for it, learning about these coping tools and other tools available to you can help you get through these tough situations. 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] 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: [email protected] |
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