February 2022 - Kate Gegg, AM, LCSW

February 23, 2022March 27, 2023

Acceptance vs Hopelessness

What if it’s hopelessness, rather than acceptance, when we tell ourselves or others “this is just how I am”?
One of the biggest precipitants to disengaging too early from treatment, to not starting treatment at all, or to not really being “in” treatment even when you’re in it are beliefs we hold about what is fixed within ourselves, what cannot be changed, and what is possible for us.
A core tenant of finding satisfaction in life centers around acceptance; acceptance of what we cannot change, acceptance of how our development shaped us and informs how we are predisposed to interpreting the world, and acceptance of what we can and cannot control.
But how do we know when we’ve accepted something that might actually be more malleable than we realize? And what about those times when our acceptance is actually just us giving up because we’ve tried but been unable to shift something?
The short answer to that question is, of course, there is no way to “know” for certain, but if something doesn’t work for you, creates problems for you, or creates problems in your relationships let that be enough of an indicator that you (and others) are probably “tolerating” rather than “accepting”.
This is because we and others will carry anger, resentment, shame, guilt, frustration, fear and all sorts of other cues that there is a problem that needs to be addressed when something disrupts us, our responsibilities, and our relationships in this manner.
So now we are in a bind, where something within us seems as though it cannot change, and yet it causes problems in such a way that we need it to change for us to find satisfaction or peace in ourselves and our relationships.
“This is just how I am”, is usually also, “this is how I have been up until now, living life as I know it, with the beliefs that I hold about how change happens and what is possible for me”.
I often find when folks are in this spot they have previously tried to make a change, sometimes putting themselves through intense scrutiny or demands (I’m going to read every book on this, try these 300 different tactics, completely turn my schedule upside down…etc).
When those tactics don’t work, or don’t work sustainably / in the long run, take that as a cue you may be substituting discipline or control for what’s actually needed; trying differently, rather than trying harder. See more in today’s post.

Many of us go into treatment (and through our lives) with a lot of unquestioned notions about what is possible for us and our well being. “I’ve always been this way”, ‘I’ve tried and never been able to change it”, and “my family is this way too”, are just a few of the thoughts that can inform our sense of what is possible for us.

Holding on to those notions also influences what we see as “on the table” for working on in ourselves or in our treatment; if we’ve made up our minds it won’t change, we’re less inclined to talk about it as actively as something that we do hold more hope around. Some of the most important moments in my work come when my client and I realize I hold a belief that something within them can change that they themselves had given up on.

When we’ve given up on the possibility that some dynamic can change within us, we are usually asking others and ourselves to live with something that isn’t working; a temper, a drinking problem, a spending problem, an intimacy problem – etc.

Giving up on the belief that something could be different for us usually follows extensive effort on our part to elicit change in the ways we know how to. If you find yourself trying to put more and more control, discipline, or strategy into it, if you’re living your life jumping through hoops for this, or, if you’ve just outright given up even though the issue remains, I’d encourage you to take your emphasis off of how “hard” you are trying and focus more on trying differently.

Unfortunately there is not one single answer to what it means to “try differently”, but it usually starts with broadening your scope of looking at the issue. This could mean accepting secondary gains you experience from the “problematic” dynamic; identifying when you are relying too heavily on pulling away from or stuffing down emotions rather than using them as guide posts to learn from; challenging difficulties with trust or boundaries; or trying to be more open to something that might actually be helpful that you don’t want to need or rely on (i.e. coping skills, medication, limits, meditation, etc).

Everyone can learn, grow, and change. Don’t give up. More in today’s comments.

Comments:

One very important key fact here: while we can change how we behave, relate, process, and make decisions we cannot change what thoughts or feelings arise in us. We can learn to tolerate them, take care of them, honor them, distract from them, and a whole host of other practices – but the content of our thoughts and feelings cannot be controlled and is ours to learn to tolerate and live alongside.
I mention the idea of “broadening” the scope of how you conceptualize the problem at hand in this post. I heard another therapist use this metaphor once and it has always stayed with me. Think about a leak in your ceiling. Where you see the wet spot doesn’t necessarily tell you where the issue is. You often have to open up more of your house than you would have guessed to take care of the leak. Our internal worlds are like that home. If we focus our energy exclusively on the target “part” of us we want to change (or leaky spot) we often miss the big picture of what’s happening, and we are at risk of it continuing to happen without getting at what the larger system (i.e. whole person – i.e YOU) needs to function well, and function consistently. Often times folks that are trying to manage a systemic issue with discipline or control are missing out on addressing the root cause of the “leak”. This would be the equivalent of painting over the wet spot, or constantly using a hair dryer on it; labor intensive tactics that don’t get to the core problem at hand.
There’s a great joke that I reference all the time in therapy – “How many therapists does it take to change a light bulb?” the answer “One, but the light bulb has to really really really really really want to change”. Now of course, it’s not that simple, motivation is hugely informed by hope and trust, which we can all lose access to based on our prior experiences (so sometimes we have to start first with building hope and trust before motivation can arise – and this can take years, especially if you have a history of relational trauma ). BUT, the key take away from the joke, which I try and help my clients with, is that the desire to change, and a willingness to have the accountability for that change come back to you (rather than others or outside forces) is one of the most important influencers of change and success in treatment. This joke also holds another important point in it about boundaries; it doesn’t matter how dark the room is, or how much change is needed/urged/requested/desired from outside forces, the desire for change still has to come from within. While we can influence others with our expressions of how they effect us, our concern for them, or our perspective on how their life could be better, we cannot (even by forcing someone to go to therapy) make people want to change without there being some desire from within them for their life to be different or better in some way.
An area where I see this attempt for control often is around food and dieting. “If I could just stop eating these bad foods I would be able to keep the weight off”, so now I don’t eat chocolate, or I only eat it on weekends, and I have to count out every nut, and fruit is bad because it has sugar – etc”. While I am not a dietician (and I have to be careful here not to speak outside of the scope of my training), I have referred many of my clients who have struggled with eating / weight problems to dietitians and spoken to those dietitians along the way about their treatment recommendations and notion of healthy eating. Without fail, I have been told that “controlled” eating is usually on the disordered spectrum, which includes any kind of restrictive diet or rule based relationship with food that classifies some foods and “good” and others as “bad”. It’s not uncommon to have to unlearn the habit of trying to eat in an intellectual manner (i.e. counting calories, only eating “good” foods, restricting “bad” foods etc) and to have to learn how to listen to cues from your body about when, what, and how much to eat. I would call this an example of trying differently; your intuition may be to double down on your discipline and efforts to control, the path out may actually be controlling less and learning to listen to you body more. If this sounds like you please listen to the actual dietitians out there: Christy Harrison (a registered dietician) has a great podcast called “Food Psych” that covers many topics related to binge eating, restricting food, dieting, the link between anxiety/depression and eating; I’ve also encouraged clients to read books like “Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food” by Jan Chozen Bays; or “Intuitive Eating “by Evelyn Triobole and Elyse Resch.
I mention how overly relying on pushing away emotions can get us into trouble. More on understanding our triggers here.
I talk about how difficulties with communication can be a common dynamic people tolerate between one another. For tips on effective communication see my posts on fair fighting and on the benefits of taking space in conflict.
One of the places we can go when we’ve given up hope on the possibility of being different is classifying ourselves or others as “lazy”. More here on how to deconstruct laziness .
Sometimes we have a lot of trouble being open to something that might really help us because we don’t think we SHOULD need it or we don’t want to need it. If that sounds like you, read this post on acceptance.
I talk more about the notion of holding accountability towards one self for the life you want to have in this prior post.
What I am writing about in this post is drawn somewhat from Marsha Linehan’s conceptual skill, “Willingness”, which she defines in her manual as, “Accepting what is, together with responding to what is, in an effective and appropriate way. It is doing what works. It is doing just what is needed in the current situation or moment”, rather than imposing your will or your sense of what is “right” when it conflicts with what is actually needed to meet your goals for the situation.

February 13, 2022April 26, 2023

IMPROVE

It does not make you inferior if a situation is more than you can handle; it makes you a person who knows your limits.
Sometimes, it is absolutely appropriate and necessary to temporarily bury feelings, hide them, or push them away. When we do this we are getting through the moment, and taking on only as much as we have capacity for.
We use distress tolerance skills as short term tools to help us manage when the intensity of our emotions is at a 9 or 10 out of 10. At those times we are at risk of coping in a manner that eases our duress for the moment, but creates problems for us down the road.
Think: substance use to numb ourselves, lashing out (verbally or physically) at others to release emotions, having an internal experience of our emotions that is so intense we can’t process what’s happening around us effectively, self-harm, or causing harm to others out of our own duress.
If you’ve ever looked back and thought, “I wasn’t in my right mind when I made that decision” chances are you could have used a distress tolerance skill to help you through.
Distress tolerance skills are not for the weak or people who “can’t handle it”, they are for any and all of us when a situation pushes us to our edge.
Remember, with distress tolerance skills we are not changing the moment, we are helping you get through the moment in a manner that will not create further problems for you once this moment has passed.
Distress tolerance skills have the added bonus of helping you “reset” so you can cope and come back online with you faculties intact, enabling you to manage the stressors ahead of you.
Using distress tolerance skills is often about getting out of black and white (all or nothing) thinking; “if I can’t make the problem go away, there is nothing I can do” is not constructive. You can improve your experience and increase your capacity to handle what is coming if you give yourself permission to use distress tolerance skills.
There is no right amount of time needed for you to be in a mode where distress tolerance skills are necessary, but generally speaking if you’re in a distress tolerance mode for more than 24 hours you may be navigating into the territory of avoidance, which creates a whole host of other problems in your life.
In today’s post I cover the skill “IMPROVE” from Marsha Linehan’s Dialectical Behavior Therapy textbook. Not every part of this will work for every person, consider this skill (and others I offer) as a buffet for you to pick and choose from for you to cope with your specific situation or stressors.

I – Imagery. If you can’t leave the situation in real life, you can temporarily use fantasy to create a new environment to be in. This skill can help us escape internal or external duress (i.e. imagining a more pleasant scenario), or, if it feels accessible, you can use it as a way of boosting yourself up (i.e. imagining yourself coping well).

M – Meaning. Terrible things happen. One way in which we can survive them is by making meaning out of them. This is often too big a task to do in the present, but what you can do is have faith in your ability to find meaning eventually. This can look like, “I don’t know how this will ever make sense to me, but I believe that I will find a way to learn, grow, and be a better person because of this”.

P – Prayer. If you are religious than this probably already makes sense. If not, think of prayer less literally as “asking god”, and more figuratively as a surrendering yourself to forces outside of your control. Prayer usually includes accepting what is happening and our limited ability to change it all while asking for help from some yet to be determined place (like from others, a future version of ourselves, our community etc).

R – Relaxing. Remember, our brains and bodies are connected in a giant feedback loop. If you are stressed, anxious, and upset your body is likely carrying that tension physically which signals to your brain the need to be on high alert (which can further heighten tension). You can interrupt the feedback loop by relaxing your body which will decrease your experience of the stress.

O – One thing in the moment. This is reviewed extensively here. This skill centers us and can reduce our experience of chaos.

V – Vacation (temporarily) from responsibilities. Also known as, a break, denial, avoidance, or time to regroup. For this to work you really have to clear your mind of the problem and focus on something else.

E – Encouragement. Our internal world can be brutal. Try shifting your internal voice to approach yourself like you would a friend or a child (with encouragement, kindness, a focus on capacity and strength, and without all the harshness that may be present for you at a difficult time).

Comments:

I write a lot in this account about the benefits of being present with your whole self throughout your day, which includes your body, emotions, thoughts, feelings, values, priorities, and the environment around you. While I absolutely stand by that recommendation, like nearly everything I’ve written about, this is not an all or nothing recommendation and the helpfulness of being present in this manner exists on a spectrum; there are times in all of our lives when we need to recognize our limits and our inability to be truly present in the moment. This post will help you identify where your limits are and, hint, often they are not where you want them to be. This post explains the rationale for distress tolerance skills. In it I cover the importance of having “distress tolerance skills” (as Marsha Linehan of DBT calls them) in your coping tool belt. I also cover how our brains respond to intense negative emotions in the comments.
Some of us may not identify with having our emotions at a 9 or 10 out of 10, but we do identify with repeatedly having those moments where we wish we hadn’t handled something in some way, or with feeling the opposite of intense emotions – nothing at all. The IMPROVE skills may be helpful for you too in those times, as well as grounding, another version of a “reset” for our brains that helps bring us back to the present and improve impulse control. Grounding skills are a version of vacation from responsibilities combined with one thing in the moment.
Another way to think about when to use distress tolerance skills is when you are outside of your window of tolerance.
When we force ourselves through a moment that is more intense than we know how to handle, without taking care of our emotional needs we are not only not using distress tolerance skills, we are at risk for experiencing the situation as traumatic. Read here for more on what makes something “traumatic”.
Your ability to use these skills heightens with a mindfulness practice, which helps us increase our ability to control what we place our attention on. See my prior posts on the rationale for mindfulness skills, for an introduction to meditation and its purpose, for sensory based meditation and for free form meditation.
Struggling with feeling like you shouldn’t “need” to do this or use these skills? See my post on Acceptance for help with this.
Are the concepts in IMPROVE new to you? That’s ok. The best way to help them become habits is to have realistic expectations for how to incorporate them into your life. See my post on how to make long term sustainable change.
A note on prayer. There are different types of prayer, why me prayers, asking for help prayers, acceptance prayers. In my experience “why me” prayers further our experience of helplessness where as acceptance and asking for help prayers are often more helpful in coping with an unfair or difficult moment.
Understanding how emotions work will help you better understand the “R” – Relax – skill. See post from November 1st, 2021 for more details on how our emotions work. As Marsha Linehan says of relaxing, “Often people tense their bodies as if by keeping them tense, they can actually make the situation change. They try to control the situation by controlling their bodies. The goal here is to accept reality with the body” by relaxing it. The quote is from page 99 of Linehan’s Skills Training Manual for Treating Borderline personality disorder, 1st edition. Full Citation: Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford Press.
Further insight into the benefits of “one thing in the moment” “O” skill, from Marsha Linehan’s manual: “Focusing on one thing in the moment can be very helpful in the middle of a crisis; it can provide time to settle down. The secret of this skill is to remember the the only pain one has to survive is ‘just this moment’. We all often suffer much more than is required by calling to mind past suffering and ruminating about future suffering we may have to endure” The quote is from page 100 of Linehan’s Skills Training Manual for Treating Borderline Personality Disorder, 1st edition. Full Citation: Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford Press.

February 2, 2022March 27, 2023

Providing Support

Most of us think to say, “is there anything I can do?” when someone we care about is struggling. While we are generous in offering our willingness to help, we may be adding to the “to-do” list of the person in need; to receive the help offered they now have to become a project manager who coordinates, organizes, and thinks up the items on their “how to help” list.
For most of us when we are really struggling we are in “just get to the next moment mode”, which means the parts of our brain that might help ease our burden (like the parts of us that can plan, brainstorm ideas, or be creative) become less accessible.
One of the most supportive things you can do to help someone in need, in addition to asking “what can I do”, is to offer your ability to plan or to be a “creative problem solver” on their behalf. Essentially, you can offer support by “loaning” your brain to their problems.
If this is not intuitive to you, try accessing your powers of empathy regarding the emotions you think they are struggling with in their current situation: Are they struggling with helplessness? Loss? Fear? From what you know of them, what provides comfort to them? If you don’t know them them that well, then offer what might provide comfort to you.
If the relationship isn’t quite that close, consider offering something concrete that doesn’t involve a need to plan or think too far ahead. Because a person in a difficult situation is often in “here and now” crisis mode you will be meeting them at their current capacity level by not asking them to look too far ahead.
We have to be careful not to let our desire to lift their burden overpower our ability to hear them when they communicate (with words or actions) what would be helpful for them. It’s not unusual for people to need space, time, or distance, which can be hard to receive when you really want to help.
The truth of it is when someone is struggling, everyone around them may also struggle with their own helplessness about their limited ability to lift the burden from them. Our own desire not to feel our helplessness can sometimes drive us towards taking too much action, or action that overwhelms the party in need.
Remember that truly supporting someone is also about showing them their perspective and preferences matter; which means not over-inserting ourselves and paying attention to cues from them about what they (rather than we) perceive to be helpful.
If nothing else, be mindful of your questions. Often, to help ourselves feel safe we want to understand “what happened’, which puts the person in crisis in a position to satisfy our desire to understand. Follow their lead about how much they want to talk, it will show them you are there for them, rather than to satisfy your curiosity.
Try and remember; you cannot take away someone’s pain, but you can ease it by “loaning” your brain and problem solving skills to their situation; by offering something concrete that doesn’t require too much planning; and by respecting their process and hearing them in what they communicate (in words and in actions) they need.

We all know that when we are experiencing a crisis we can’t “think straight”. Translated into more concrete terms, this usually means the times when we need help the most, we struggle to identify our needs, articulate them to others, and think ahead about what will help moving forward.

For many of us, our “crisis mode” is not one that is particularly good at planing or creativity, two parts of our intellect that are often most useful when we find ourselves in an overwhelming situation. Put simply, we struggle to slow down and think step by step about what we need, the situation needs, and our future selves will need.

If you are trying to support an individual or family in need you can – of course – start with “is there anything I can do to help?”. Some folks like to feel a sense of control and do have ideas for what they need, so it’s a helpful starting point. You do not, however, necessarily have to end there.

Offering your abilities to plan, identify creative ideas, or offering to do something concrete (like get groceries) actually offers two things – whatever it is you offer – and something less tangible; the brain power we lose access to when we are struggling, in a crisis, or busy trying to wrap our heads around digesting difficult news.

Do remember, there can be a delicate balance between recognizing when it might be helpful to do some thinking or acting on someone’s behalf and inserting yourself too much. Often times our eagerness, desire to help, and desire not to feel helpless ourselves, can interfere with our ability to listen in the moment to cues or words that indicate someone wants or needs less from us. This means, make your offer, but receive their answer, and recognize receiving their answer is a way in which you are supporting them.

Finally, be mindful of why you’re asking questions about “what happened”. Your curiosity is natural, but remember that it most often serves your desire to understand, rather than the other party. If you are there to provide support, offer to talk, keep an eye on the allure of satisfying your curiosity, and follow their lead about how much sharing or revealing they’d like to do.

Comments:

Ok, so how do I do all of this? One way is to offer support openly (in the event they have ideas) while also offering some ideas you’ve come up with, like, “Please let me know if there is anything I can do to help. One idea I have is that I could get you groceries. I could also bring by some puzzles for Johnny to play with with he’s recovering? Let me know how that sounds”. Then, it becomes your job to listen to how they respond, which includes what they say explicitly and what they don’t say. Ultimately, a part of supporting someone well is recognizing the line between where our needs end, theirs begin, and the intersection of the two. We want you looking for cues from them that what you are offering and providing is useful to them.
A helpful tool that I have come across over the years for individuals in crisis, or in need of coordinating support from groups of people is called Caring Bridge. This is a way to keep people updated on “what’s happening”, as well as coordinate ways to help on a shared schedule / in a shared system. As a reminder I post resources I believe are valuable, and I do not accept compensation of any kind from third parties I endorse. I am suggesting this because I have seen it be helpful to families in need in both my personal and professional life, and it’s a resource I’d like to share.
I have a tangentially related post on this topic – about what happens when our desire to serve our own needs for safety can interfere with our ability to effectively process something terrible that’s happened to someone else. This is usually not the case when we are trying to provide support to others, but it’s another version of how our needs can get tangled up in the situation we are observing and can then skew our perception.
Helping others can get us into sticky territory with boundaries. When you’re providing support, remember to pay attention to what you need too. Posts to help with that include my post on finding balance in relationships, which walks you through how to keep an eye on yourself and the other party; My post on finding balance between “shoulds and wants” can help you reflect on what is driving you to provide support to others; and my post on building insight into recognizing where your limits actually are will be helpful if you find yourself in positions where you over-extend.