Healing, Not Fixing, PTSD

 

Post-Traumatic Stress Disorder (PTSD) is often best approached as a chronic condition that may have “flare-ups.” This is true of many other mental illnesses and mental injuries as well.

It can certainly be the case that someone experiences some symptoms of PTSD one time and never again in their life, but for most of us, what it means is that we are vulnerable to experiencing symptoms again during periods of stress (or in the case of activating events).

We are experiencing healing, which means we are able to improve certain things with support and as we learn to attend to ourselves, but we don’t know how much everything will heal nor how long it may take. This is different than “fixing,” which is when we remove a “broken” part and replace it, and then everything is as though nothing ever happened. You are an organism, not a bicycle.

This does not mean “I have PTSD, so now everything is hopeless forever,” it means that we need to learn how to manage our environments, life situations, and our selves in order to reduce the severity of symptoms and the likelihood of recurrence, rather than to assume “I haven’t had any symptoms in a year, this must mean it’s okay to stop attending to myself!”

It means not subjecting ourselves to unreasonable stressors and life-sucking situations, personally and in our work. It means taking our physical and emotional discomfort seriously instead of blowing it off until it blows up. It means not listening to internalized minimizing messages that say “suck it up” when distressed. It means learning to re-parent ourselves where necessary.

It means treating ourselves with support, care, and dignity, and developing boundaries to ensure that others do, too. It means practicing self-care as a habit, not only when unduly stressed. It means recognizing symptoms as symptoms, rather than as some kind of weakness that deserves self-punishment.

It means learning what events, people, and circumstances make your symptoms worse, and modifying those as best you can. It means learning what activities, people, and circumstances help you feel better, and including those more. It means taking yourself to the doctor or the therapist when you need to go. Sounds simple, but it’s not always easy!

Basically, it means learning to take care of ourselves “as though” our well-being actually mattered instead of as an afterthought. Let me repeat: treat yourself like your well-being matters, because it does. ❤

 

“Treating yourself with kindness is a life skill. It doesn’t matter whether you are ”good at” this skill It only matters that you keep going💛” — Jeffrey Marsh

 

 

Someone Said I Did A Racism; Now What? A Guide

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It’s the final day of Black History Month!
The past month has seen a number of high-profile figures being criticized for saying or doing racist things. In most cases that I saw, those in the spotlight made matters even worse by their responses. Have you wondered how you would respond in the same circumstance?
Nobody wants to think of themselves as racist. But the fact is, being raised in a racist society means that some of the time, we will all do or say some racist things, despite meaning well and often without even realizing it.
So what do you do if someone points out that what you have said or done is racist? Here is a guide.
1. First of all, hold that initial impulse to argue. Before you say anything, take a breath and pause for several seconds. If you must speak, say something like, “Okay. I need to think about this.”
2. On the emotional side, contain your defensiveness: Doing or saying a racist thing doesn’t necessarily mean that you are a bigot or a terrible person. Most people doing racist things are not bigots. It does mean that a piece of (very common!) racist conditioning has come up and it’s an opportunity to work on that and heal. If you are a person with a conscience and a heart, it will probably hurt to hear. That means your conscience and your heart are working! But try not to take this criticism as an attack. (This is hard!)
3. Recognize that your intention doesn’t excuse the outcome: If I run over your foot with my truck, it doesn’t matter whether I mean to or not. Your foot is going to be hurt–possibly broken. The same is true of racist acts and words. The vast majority of racism is unintentional, and it is injurious to others just the same.
So it’s okay if you find yourself saying “I didn’t mean to…” But recognize that is only the beginning, and only a tiny piece of the issue. It’s not an apology.
4. Try simply apologizing unconditionally and without a long explanation. It’s okay to say something like “I’m sorry. I see that was ugly.”  If this sounds hard (it is, emotionally speaking), try preparing by reviewing and practicing before this ever comes up, so you won’t be frozen or outraged if it happens. You may also want to review what not to do!
5. Manage your own feelings: This is really the hardest part.
Most of us, if not all, will feel defensive, hurt, attacked, misunderstood, guilty, sad, scared, angry, or some combination of the above. But those feelings are yours to manage, and you are strong enough to hold them.
Remember, the other person is not responsible for making you feel better for having hurt them, or to give you absolution. It’s especially important to let them have their feelings of upsetness without trying to talk them out of it or to burden them with the emotional work of reassuring you about it. That places additional work on them when they are already burdened with the hurt of racism, and it is unfair.
If you need to vent your feelings about this (which is healthy!) find someone else to talk with, preferably a racially conscious White friend or even a counselor. You may also want to journal, cry privately, read, pray, or meditate, just as you would with any other painful or uncomfortable feelings that you are processing.
6. What if they are wrong? Short answer: they’re not. Even though you didn’t mean it that way.
Think about it: if you are a White woman, haven’t you seen men doing sexism even when they didn’t realize it? Or they dismissed it? If you are a White person who is LGBT: haven’t you seen hetero people being homophobic or transphobic and then saying how much they love LGBT folks? Low-income people, haven’t you heard rich people talk about poor people like they really don’t matter at all in the ultimate equation? Yet if you asked them, they would probably say they like people generally, and had nothing against any particular poor person.
The worst judge of an -ism is the person committing it, and racism is no exception.
7. Don’t be discouraged from working on race issues: Pick it back up when you have healed. Think about your motives. Are you working on unlearning racism because it’s the right thing to do, or to get approval and recognition from people in a marginalized group? Work on race issues because you want to improve society, whether or not any specific BIPoC likes you (or you them). Unlearning is a lifelong process.
8. Develop authentic friendships: It is always more emotionally risky for a BIPoC to have a White friend than the other way around. So make yourself available, be friendly and helpful insofar as you are able, but remember that no one owes you friendship, no matter how nice you are to them. To borrow an analogy, friendship is not a vending machine.
For additional thoughts about interracial friendship, visit this thread:

PS: Whatever you do, resist the urge to do a “not all White People,” –no really, do not do a “not all White People.”

 

Know Your Personal Rights: With Explanations!

Based on the Personal Bill of Rights from The Anxiety and Phobia Workbook (Edmund J. Bourne):

 

#1: I have the right to ask for what I want.
You are allowed to ask. You don’t have to mind-read beforehand to make sure the answer will be yes. You don’t have to swallow everything you want or like or need. Sure, it’s possible the answer will be “no,” but you can prepare for that possibility. It’s not wrong to ask.
#2: I have the right to say no to requests or demands I can’t meet.
Just because someone asks (or demands) something, you are not obligated to do what they want. You are also not required to come up with justifications, apologies, or rationalizations for saying no. It’s okay to just say, “No, I’m sorry, but I’m not going to be able to do that.”
#2 is also the corollary to #1. If at some level you believe people are not “allowed” to say no, you may feel guilty asking for anything because it feels like you are “forcing” someone to do what you want. (And you may resent others asking anything of you for the same reason.)
You are allowed to say no to others, and others are allowed to say no to you. (That’s how autonomy works.)
#3: I have the right to express all of my feelings, positive or negative.
You are allowed to have feelings, whether you or others think they “make sense” or not. You can acknowledge a feeling to yourself or to others. Emotions are your feedback system about events, whether in the outside world or within your mind. As such, they aren’t “right or wrong.”
Thoughts and judgments generated by feelings can be true or untrue, reasonable or unreasonable, but the feelings themselves are not right or wrong.
For example, you can feel scared about something that wouldn’t scare most others. The fear is still real, even if there is no threat. Likewise, you can be sad, or angry, or even happy about something that doesn’t make sense. The feeling itself is still real.
So it doesn’t make sense for someone to say, for example, “You shouldn’t be sad about that.” If you’re sad, you’re sad. Or, it’s okay to tell someone, “You’re scaring me,” even if they believe they have a right to shout at you, or tell you you “shouldn’t” be scared.
In fact, telling someone your responses to their actions is an important thing for them to know about how their behavior affects others. (If it’s not safe to tell them how you feel, then that relationship is not safe.)
A good formula to express feelings to self or others is “I feel ______________ when ___________ happens.”
“I feel anxious and vulnerable when there’s violence in the news.”
“I feel abandoned and angry when you forget to pick me up.”
#4: I have the right to change my mind.
It’s okay to try something and then realize you don’t like it halfway through. It’s okay to discover your feelings about a person or situation have changed. It’s acceptable to learn and grow and develop new beliefs. You do not have to continue something you don’t like.
#5: I have the right to make mistakes and not have to be perfect.
It’s often much easier to apply “no one is perfect” to others, while still beating yourself up for mistakes or “flaws.” This is usually an internalized voice that is just waiting for any chance to criticize. Whosever voice that was, you don’t have to keep repeating that tape.
It’s certainly valid to try doing something differently if that works better in your life, but you are already acceptable, even as you are “messing up” or being flawed. Too many people are waiting until they achieve perfection to love themselves, and they will wait forever.
It can be invigorating to strive for excellence, but “the perfect is the enemy of the good.” This means that you may end up doing nothing at all if you can’t do it perfectly (which no one can).
#6: I have the right to follow my own values and standards.
You are allowed to wear clothes that others think are too childish, too weird, too sexy, or too boring. It’s really none of their business. It is your choice if you want to eat vegetarian food or to include meat. It’s not wrong to have sex or to completely abstain. YOU choose. If you want to go to church, that’s your business. If you want to not go to church, that is also your business. If you want to be a parent, great! If you want to be child-free, great! You don’t have to legalistically justify your values to someone else.
#7: I have the right to say no to anything when I feel I am not ready, it is unsafe, or it violates my values.
You are allowed to say no when you need to! (See #2.)
#8: I have the right to determine my own priorities.
No one else can live your life for you. It’s not a trial run. Prioritize what is really important to you, which may not be what your friends, parents, or society expect. They get their own turn. This is yours!
#9: I have the right *not* to be responsible for others’ behaviors, actions, feelings, or problems.
This one is tricky. People misinterpret it to mean that it must be fine to be selfish and you should not care how you treat others or how they are affected by you. That is not what it means.
It does mean that you are allowed to take your own side. You are allowed to take care of yourself, physically and mentally. You do not have to set yourself on fire to keep others warm.
It means that ultimately you cannot control how others respond to you. For example, if you are “walking on eggshells” trying not to upset someone, then at some level you believe you can (and must) manage their feelings — to make things okay for them. This is not true!
It means that if someone is abusive to you, you did not “cause” it, because you are not responsible for others’ behaviors — they are. It means that you don’t have to keep rescuing someone, especially from problems they create, because you are not responsible for their problems.
The reverse is also true! If someone is hurtful to you, you are the one responsible for protecting your feelings from further injury, whether by telling the person to change how they treat you, or by ceasing to interact with them (insofar as that is possible) if they do not.
#10: I have the right to expect honesty from others.
A relationship without honesty is not a relationship, but rather a one-sided experience for each partner.
#11: I have the right to be angry at someone I love.
Too often people imagine that love and anger are incompatible. But we can hold many contrasting feelings at once! If someone hurts or disappoints you, it’s natural to feel angry. We don’t want to express anger in an abusive way, but feeling and expressing anger is to be expected.
#12: I have the right to be uniquely myself.
“Wanting to be someone else is a waste of the person you are.” Your individuality is to be celebrated. That doesn’t mean others are wrong to be who they are. It means that you get to be anything from “boring” to “weird” if it makes you happy and fulfilled (and so do others!)
#13: I have the right to feel scared and say “I feel afraid.”
Feelings are not wrong in and of themselves. No one can tell you that you “shouldn’t” feel afraid (not even you). You do not deserve to be mocked into ignoring your vulnerability or your wish to be careful, even if your fear is not based on a reasonable threat.
#14: I have the right to say “I don’t know.”
You don’t need to be pressured into making a decision when you are unsure. And you can’t be expected to know everything — no one knows everything! It’s reasonable to take the time to figure out what you don’t know.
#15: I have the right not to give excuses or reasons for my behavior.
If you want to explain to someone, you certainly may. But too often people feel they *must* come up with scrupulous, legalistic, unbreakable explanations for everything they do.
Who are you allowing to judge you? You don’t have to put yourself one-down to someone else’s judgment. After all, you don’t judge them and argue every little thing they do, right?
#16: I have the right to make decisions based on my feelings.
Pssst! Here’s the big secret: ALL (yes, ALL!) decisions are based on feelings. Someone who tells you otherwise is not very self-aware, and they are rationalizing their own (feelings-based) decisions in hindsight.
What about logic? What about rationality?
Yes, we want people to be rational and to be logical. That’s the best way to get the outcome you want… and “want” is a feeling. Without feelings, there is no reason to do anything at all. You are not an automaton, nor is anyone else. Logic incorporates rationality AND feelings in deciding your path. If you believe something will make you happy and you know (rationally) how to do it, then logic says “try doing that thing.”
There is no such thing as “pure logic” or “pure rationality” in terms of human behavior.
All desired outcomes are feelings. For example: “I want to have a house and a car [because I will feel satisfaction].” or “I want to become a physician [because I will feel better if my parents are pleased].”
So if someone criticizes you for deciding things based on your feelings, they have absolutely no grounds for criticism. It is completely illogical to exclude feelings from decision-making!
#17: I have the right to my own needs for personal space and time.
Whether you need a little or a lot of alone time to recharge, then you are allowed to take that time. Others may *want* more of your time than you have available, but it’s not your responsibility to sacrifice taking care of yourself to fulfill their wishes.
You can’t give to others from an empty well!
#18: I have the right to be playful and frivolous.
It’s okay to have a childlike side. That’s part of what keeps you alive and happy! It doesn’t mean you are are not to be taken seriously, or that your needs should be ignored, and it doesn’t mean you can’t also be a competent adult.
#19: I have the right to be healthier than those around me.
When you begin to set boundaries, take care of yourself, and ask for needs to be met, you may be met with resistance from those still caught in dysfunctional dynamics. You are allowed to take care of yourself even if others aren’t, and you can’t save them by sacrificing yourself.
#20: I have the right to be in a nonabusive environment.
You are not required to tolerate a stressful and abusive environment just because you know how to do so and have done so in the past. A big part of therapy is *lowering* your tolerance for BS so that you will get out of bad situations before they get terrible!
#21: I have the right to make friends and be comfortable around people.
If the atmosphere in your childhood environment was insular and suspicious, you may feel guilty about being social or out in the world. But those are part of your rights as a human — to connect with other humans as you see fit, to like and love those you are drawn to.
In an abusive relationship of whatever kind, someone may seek to make you feel guilty for or afraid of having any connections besides the abuser. This is a control mechanism, and is not healthy.
#22: I have the right to change and grow.
“But you didn’t use to mind when I did X” … It’s okay to say, “Well, now I do mind, so please don’t.”
#23: I have the right to have my needs and wants respected by others.
It’s also okay to limit or cease time spent with those who do not respect your needs, wants, and boundaries. Even if they are loved ones.
#24: I have the right to be treated with dignity and respect.
Again, it’s okay to limit or cease time spent with those who do not treat you with basic human respect. Even if they are loved ones.
And don’t confuse “respect as an authority” with “respect human rights”:
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Finally, #25: I have the right to be happy.
The simplest but by no means the easiest to accept.
(Previous post about personal rights here.)

What Attending Therapy Is About: (AKA We Are Not Just Sitting Here Chatting)

Everyone’s approach to attending therapy sessions is different: people’s needs, symptoms, and circumstances vary incredibly. People want and expect different things in session.

Clearly, there are specific, well-researched interventions that are likely to be effective with most people who experience a certain symptom or pattern of behavior. Some interventions can be practiced in a therapy session, and some interventions are good for a client to take home and practice on their own. I do have plenty of handouts to work on and books to recommend that you read!

But not every intervention is on a list of tips that I’m going to print out and give you outright, or on a sheet in a manual with steps 1, 2, and 3. In fact, nearly all of what we are doing while in session is an intervention, even if I do not formally announce it as such. That is to say, we are not just sitting here chatting, even if sometimes that’s what it appears to be.

When I’m asking about your week, or how you feel, if you’ve gotten over your flu, or how things are going with your family or job, for example, I’m actually assessing your anxiety, depression, hypomania, behavior patterns, physical well-being, environmental influences, sense of hopefulness, and any changes in how you are interacting…for starters.

But I’m not just gathering data. I’m also intentionally getting you to practice certain kinds of conversing, thinking, and interacting during session.

I’m getting you to practice speaking openly about things that may have felt “unspeakable,” uncomfortable, scary, or just awkward. I’m reframing or redirecting your thoughts as you speak them from “shoulds and musts” to “preferences and wants,” so that you can begin to change your internalized messages. I am giving you the chance to practice openly experiencing and expressing feelings in the presence of someone who will not censor or scold you for how “irrational” or “unacceptable” they are. I am often taking the role of defending you from your own inner critic! I am supporting you in developing an attachment that is not based in power and control or other unhealthy dynamics. I’m also simply being a trained witness to your life; checking in with you over time to see how you are changing and making sure you are okay.

Developing different patterns of thought and interaction takes time, and it’s a great deal more powerful if done with another person. That is why sessions are “booster shots” even for those who do a lot of internal work on their own. Humans are social creatures. Everyone, even introverts (like me!) must interact with others in order to process and develop emotionally.

And you know I can tell you’ve been making real progress when you stop yourself from saying “should” in session before I can give you the “shoulds” lecture yet again! ;D

So that is why–even if I didn’t give you a handout to take home or a list of suggested solutions to your situation–you made a LOT of progress in your session today.

Remember, “talk therapy” actually changes brain structure!

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Know Your (Personal) Rights

Most relationship difficulties are a result of some kind of difficulty in setting boundaries. If your childhood environment was chaotic or abusive, you may not have been allowed or encouraged to have personal boundaries, so you may need to learn to develop them in adulthood.

In order to develop good personal boundaries, you need to know what rights those boundaries are defending. If you haven’t thought much about your personal rights, you might not even know what they are! In that case, a good place to start is the Personal Bill of Rights from The Anxiety and Phobia Workbook (Edmund J. Bourne).

Personal Rights

Click here to see further explanation of individual items on the list.

You Are Not “Lazy”

“I’m not getting enough done, I’m so lazy.” “I ended up hardly doing anything Sunday and I felt so lazy.” “I need to get this one task done, but I keep being lazy about it.” “After work I’m just too lazy to work out.” “I’m too lazy to keep track of things.”

In fact, I have never met a lazy person.

I’ve met people who are: overworked, exhausted, sleep-deprived, in chronic pain, ill, mired in depressive episodes, struggling with anxiety, stuck in intolerable situations, and having attention difficulties, but I’ve never met a lazy person.

“Lazy” doesn’t really mean anything clinically. It’s a “folk” term, and it is primarily used as a pejorative towards self or others. One patient summed it up as “not doing what you think you ‘should‘,” and I think that’s a good all-around summation.

Calling yourself “lazy” is usually an internalized message from caregivers in your formative years. It could have been directed towards you or towards others. The message is “You are unacceptable unless you do what I want, regardless of your ability, wishes, or how you are feeling.”

If you are injured, walk it off! If you are tired, too bad! If you are sick, it can’t be that bad since you’re not actually in an ambulance on the way to the hospital! Just because you don’t want to do something is no reason not to do it! You’re just “lazy”! In other words, how you feel and what you want do not matter. Ignore your own feelings and your wishes.

“Lazy” has also been used (and still is) as a way to demean racial minorities, those with disabilities, the poor, and women. Please be especially careful not to re-enact racism, ableism, classism, and sexism on yourself by calling yourself lazy!

The implication is that if you would just “will” yourself to do whatever it is, then you would be acceptable and worthy. If not, then you must just be a bad, unworthy person and you must deserve bad treatment.

The fact is, you are already acceptable and worthy, without doing anything to “earn” that worth. Now, you might feel better or happier if you were doing certain things, and they are certainly worth trying, to see if that is the case. But telling yourself you are “lazy” is not helpful.

Feeling awful about yourself is not a good motivator for anyone. And it is in no way helpful in mitigating situational factors, such as poverty or prejudice. In fact, it is likely to worsen your exhaustion, depression, anxiety, insomnia, and concentration, which will make it even harder to do whatever it is you would like to be doing.

Instead of calling yourself lazy when you did not do something you intended to, try paying attention to your feelings. Are you tired? Has it been weeks since you had a good night’s sleep? Have you been working 60 hours at three different jobs? Do you have an infant or a toddler? Are you taking care of others’ needs? Are you sick? Are you getting sick? Are you going through an exhausting life transition? Are you grieving? Are you experiencing chronic pain or illness? Are you in a depressive episode? Are you experiencing anxiety/phobia about certain tasks? Do you have PTSD? Are there systemic barriers to your tasks that make them much harder than they are for others? Have you been paying attention to self-care?

It may be that you have internalized some unrealistic expectations for what you “should” be able to do. It may be that some others can do the thing you want to do. It may be that on “good” days you have been able to do twenty times as much as you are doing today. But where are you, just you, today, right here, right now? Maybe you’re doing the best you can with what you have at your disposal right now. Maybe that is enough.

Another day, you may be able to do something more or something different. But accepting yourself right now is even more important than doing the thing. And that does not make anyone “lazy.”

 

Therapy Changes Your Brain Structure

Experiences change our brains. Not just in some vague way, but the structures and functions of our brains.

It’s true that our earliest experiences cast the longest shadows on our lives. But we can still heal and change our brains in positive directions throughout our lifetimes.

Yes, medications affect brain function directly, but “talk” therapy can also change your brain. For example, the more you practice thinking in a certain way, the more it becomes automatic.

If you were raised with conditioning (traumatic experiences, chaotic or abusive household) that led to depressive and anxious thoughts, you can practice new ways of thinking that will help to re-condition your brain. This is certainly not to say “just think cheerful thoughts and everything will be fine.” This is about targeting certain patterns of thoughts that you may not even realize you experience.

Thoughts are not the only part of your mental conditioning that can be re-trained, but they are often a good place to start.

Even severe conditions such as schizophrenia can show improvement in brain functioning through “talk” therapy, as research continues to show.