Blog - Page 5 of 7 - Kate Gegg, AM, LCSW

July 5, 2021March 27, 2023

Long Term Vs Short Term Self-Care

Care of the long-term self is just as important as care of the short-term self
When we care for our long-term self we make an investment in the future or prioritize what feels sustainable to us with regard to our energy, our commitments, our values, and our limits. We trade off what might feel comfortable or bring joy in this moment for something that will help life be more full at a later time.
When we care for our short-term self we do something that helps us feel good, relaxed, or at peace in the moment. Often we have fun, are in the present, and aren’t as focused on “what’s coming up”.
You will be at risk for cycles of depression and burnout if you don’t pay enough attention to caring for the long-term self OR the short-term self.
Taking care of your short-term self is essential to happiness and well-being. We can’t be happy in our lives if we’re not experiencing positive emotions on a regular basis.
If we over-invest in our short-term self we are avoiding addressing our future, which can leave us feeling anxious and uneasy as we know, deep down, we are “kicking the can down the road” and not addressing our long-term needs and well being.
If we over-invest in our long-term self we can be cheap, grumpy, or unhappy in our day to day lives. We can miss out on important experiences and opportunities.
We can stretch ourselves too thin when we over-prioritize either self. With over-prioritizing of the long term self we can live life without enough regard for the present, and we can miss out on positive experiences feeling like we’re always reaching never arriving. With over-prioritizing the short-term self we can over-commit, over-schedule and not set ourselves up sustainably leading to cycles of overwhelm and burnout.
Each of us has a different “balance point” between these parts of ourselves, and that balance point changes at different stages in our lives (meaning this is a consideration to revisit again and again).
Takeaway: when you’re trying to engage in “self-care” remember both your long-term and short-term self. If you’re noticing cycles of burnout think about how much you are considering either self in the decisions you make about how you spend your time, money, and energy.

For many, “self-care” routines can feel like a cycle of burnout, rest and repeat. We hear suggestions when we’re at the end of our rope like “get a massage”, “take a day off”, “try a yoga class”, and yes – all of those are absolutely self-care. I would classify them as “self-care of the short-term self”.

Having a special / positive experiences can make a day better, but ultimately if our version of “self-care” only cares for our short-term self we can neglect the needs of our long-term self. If we don’t care for both aspects of ourselves we will struggle with satisfaction, happiness, and leading a sustainable life.

Caring for the long-term self is about taking control (where you can) to set life up with regard to what feels sustainable, manageable, and not overwhelming to you. It’s also about making some decisions with respect to your future and prioritizing the experience of your future self. Caring for the short-term self is much more about what will be fun or feel good in the moment.

When we have a history of trauma, or when we are in survival mode we are more inclined to not consider the long-term self, as it can take a sense of safety in the world around you to believe that you can invest in yourself and your future; the more safety we feel in our lives the more able we are to consider both our long-term and short-term selves.

Many of us are inclined to lean towards caring for the short-term self or the long term self, and for each of us we need to find the right place of balance. Places to look for clues as to where you fall on this spectrum are how you spend your free time, spare money, and extra energy. How much of each do you allow yourself to “save” or “spend”?

While the popular and common notions of self-care do take care of (and are important) for the short-term self, we need to remember the long-term self. If you are in a cycle of burnout at work or with family or friends, short-term self-care may help you feel better in the moment, but what’s needed is long-term self-care to interrupt a cycle that’s got you stretched too thin and out of balance.

Notes:

This post covers topics similar to those covered in my post on wants versus shoulds.
Marsha Linehan’s Dialectal Behavior Therapy treatment covers the need for regular positive experiences and it is her treatment protocol that prescribes it as essential for a happy life. Per the treatment plan, without regular positive experiences no one, regardless of their privilege or circumstances, can be happy and satisfied with their lives.
Sometimes this concept is best understood if you think about how it applies to money. If you spend all your money on a goal for the future and very little money on experiences that make you happy or comfortable in the moment you are likely to be putting a premium on your long-term self at the expense of your short-term self. Alternately, if you spend all your money on the here and now, (things that bring you temporary joy like vacations, nice food, or items that won’t appreciate in value in the long-term) you are taking care of your short-term self at the expense of your long-term self. There is such a thing as not preparing enough for the future, BUT there is also a thing as preparing too much and missing out on present-day experiences, living too cheaply or in a way that leaves you stressed out and frazzled.
The more privilege we have the more control we have over factors like how much we work, how much vacation we take, how much money we have to save or spend and how much we time we can spend on leisure vs work. This concept can be applied relatively, and regardless of your level of privilege you can work towards caring for yourself by working towards considering what will help you feel good now, what will help you feel good later, and trying to find a balance between the two.
What about vacations? Vacations are an incredibly important tool to reset, have new experiences, relax, learn, spend time as a family, and (temporarily) reduce burnout. However, there has been research that shows that the effects of a vacation wear off very rapidly after a return to work and those effects diminish even faster with a more demanding workload. Vacations are great, but you are more likely to find happiness by paying attention to your day to day experience and finding ways to improve that then relying on vacations to “reset” you.

June 30, 2021November 8, 2021

Thought Management Tool

Anxiety can be a runaway train. The following six step thought management tool helps you slow it down and regain control.
Step One: identify the raw worry thought. Just get it out there. It doesn’t matter if once you write it down it seems ridiculous.
- Example:
  - I’m going to fail at giving this presentation
Step Two: Rephrase the worry thought so there is descriptive (rather than judgmental) language. This will enable you to get to the “core” of the worry.
- Example:
  - “I’m going to fail at giving this presentation” BECOMES
    - I’m going to freeze up and not be able to remember all the points I want to present
    - People won’t think I’m smart / capable
Step Three: List out all the reasons why you believe this worry could come true.
- Example:
  - People can be judgmental
  - people that don’t know me well may draw conclusions about how capable they think I am from this presentation
  - I have frozen up during presentations before.
Step Four: List out all the reasons why you believe this worry won’t come true.
- Example:
  - People that know me are likely to use this presentation as only one instance in their sense of me and who I am
  - People that don’t know me will hopefully trust that I was assigned this presentation because others believe I can do this
  - I don’t know that people will be as quick to jump to conclusions as I fear
  - There will hopefully be opportunities to gain respect (even if I lose it) in the future
  - I haven’t always frozen up at presentations. Sometimes they go ok.
Step Five: Now identify your priorities, goals, and what really matters to you about the situation you are in.
- Example:
  - I want to build my reputation at this company as someone that is reliable, capable, and a valuable member of the team
  - I want to be given more opportunities like this in the future
  - I want to build my confidence so I’m not always so anxious before presentations
  - I want the presentation to go well (i.e. I, my boss, and the client are satisfied with it).
  - I want to get better at giving presentations
Step six: Identify what you can do to address the worries you hold (with respect to the priorities you’ve established), how you can troubleshoot for the things you know are likely to “go wrong”, and how you can help yourself feel more comfortable.
- Example:
  - I want to ask someone who has presented in front of these people before how “tough” an audience it is so I can be prepared for what to expect
  - I can remind myself that if people judge my intellect or my capacity based on one presentation then that’s not in my control and it’s short sighted on their part
  - I can practice before hand to feel more confident
  - I can remember to pause and collect my thoughts for a moment if I need to
  - I can bring bullet points with me so I remember the key points and one of my bullet points can be the remember to pause and collect my thoughts when I need to

One of the challenges with anxiety is that it can accelerate our thinking. We can get overwhelmed quickly – to a point where we can’t identify what we are thinking or feeling, we just feel anxious, out of control, and (often) helpless to stop it.

Therapists work to help their clients slow down the speed of anxious thoughts and come to understand them. The tool in today’s post helps you slow down worries, understand key concerns, reduce helplessness, and feel more in control (which is often one of the reasons anxiety gets so severe). This tool gets you focused back on what matters to you and what you CAN control.

I recommend starting with writing this down or typing it out. In time, this may become automatic enough that you can do it in your head.

Step One. Raw Worry thought(s). You may have many, that’s ok, run through the exercise with each of them. The point of this column is to try and put words to the internal chaos so you know what you’re working with. Sometimes just clarifying the worry can help reduce anxiety.

Step Two. Rephrase the worry thought so there is descriptive (rather than judgmental) language. Judgments are often short-cuts that stop us in our tracks and leave us stuck in developing a plan of action. Substitute words like good, bad, right, wrong, should, shouldn’t, fail, succeed, hard, and easy with more descriptive language. See posts from 4/11-4/15 for detailed instructions on how to do this.

Steps three and four help challenge the likelihood of the worry coming true by forcing you to really think through the possibilities of what could happen.

Step Five: Pause and think through priorities. Look out for judgmental language here (i.e. instead of I want to do a “good” job, define what a “good” job means). The priorities for the situation don’t have to link up to the prior steps. This is a centering step to help you get to the heart of what matters to you and in this situation.

Step six: This gives you actionable steps, reduces helplessness, empowers you, and helps you gain control where control can be had.

After completing the exercise you are likely to feel centered and able to take steps to move towards meeting your goal(s)

Sample completed tool below for anxiety about giving a presentation:

Notes:

Deconstructing judgments is a key step and one that may require more detailed instruction. If you’re getting stuck on this step read this post to help you identify a judgment, this post to learn more about how judgments limit us, and this post to learn more about how to deconstruct a judgment.
I developed this tool, but it contains concepts merged from DBT and CBT

June 23, 2021March 27, 2023

Secondary Gains

If you have been trying to make a change in your life, but find yourself unable to sustain it, you may want to consider “secondary gains”
Secondary gains are the positives or benefits associated with something that is otherwise problematic in our lives
Often, we are so focused on how a behavior, choice, or response is “a problem” that we don’t see how it benefits us
Sometimes there are perks to thought patterns, reactions, ways of relating, or behaviors that otherwise concern us or the people around us.
We may not be aware of the perks, and it can take active reflecting and internal exploration to identify how we may be benefiting from something we or others in our lives identify as problematic
For example: Maybe our angry outbursts help us regain control, or help us feel powerful at a time when we’re feeling helpless. Maybe our excessive drinking helps us feel confident and enables us to be relaxed and in the moment in a way we otherwise struggle with.
Sometimes, our secondary gains are actually concepts that we hold onto – concepts that help us manage in our lives and in the world at large.
If you are finding yourself stuck, and unable to make a change despite your best efforts it’s time to consider if there are secondary gains.
Once you’ve identified them, you may need to reconcile how to receive those “gains” elsewhere from other concepts, actions, or behaviors, or if that’s not possible than face the losses that may come with making the change you want or need to make.
Further explanation in post and detailed examples in comments.

Despite our best efforts and intentions sometimes we find ourselves unable to make a change. We can get stuck in a pattern of doing something we desperately wish we could stop. This can apply to any change we want to make, from how we think about things, to behaviors, to substance use, or relationship patterns. We know our choices, responses, or how we are handling ourselves is not what we want, yet we cannot stop or break the pattern or cycle and engage in a new way of being.

As a therapist, when I hear about situations like this I will find myself curious about possible “secondary gains”. Secondary gains are some added benefit, something positive, some way in which some part of this pattern or cycle actually DOES benefit you.

When I start asking clients about this, I often get a lot of “nothing. There are no benefits. I hate that I do this and I wish I could stop”. It can be hard to “flip the script” and start thinking of how something you dislike about yourself or your choices actually serves you or benefits you.

Even for problematic patterns, behaviors, or choices there may be positives too, positives that we would lose when we make a change, and positive that draw us back into the cycle again and again. These positives are the “secondary gains” that can make change difficult.

So, while it might be something we wish we weren’t engaging in, sometimes the only way for us to make a change is for us to allow ourselves to consider how we ARE benefiting from it. To do this, we often need to actively suspend our narrative that “it’s bad” (even if we know it’s problematic) and give ourselves permission to list out what is good, helpful, unique, or powerful about it. That work, of being honest with yourself about what is “good” about this “bad” thing can bring about some difficult truths, but it is essential for you to get in touch with them to get over the road-block of secondary gains.

Once we can get in touch with how we are benefiting, we can figure out how to get those benefits in other areas of our lives, or process and accept the losses that will come with making a change.

Notes:

Example: Imagine you want to slow down your drinking. You’ve make a lot of efforts to cut back, but you can’t seem to stick to them. It might be helpful to consider what you would lose if you cut back on your drinking. Maybe alcohol helps you relax in a way nothing else does, maybe it drowns out your anxiety in social situations. If you work on increasing your capacity to relax, or decrease your social anxiety you may no longer need the secondary gains of alcohol and it may be much easier to cut back.
Example: You can’t seem to stop snapping at people in your life (i.e. yelling) when you’re frustrated, overwhelmed, or upset. You know this is an issue, and you feel ashamed about it, but you can’t seem to change the pattern. Perhaps it’s helpful to consider what you gain by KEEPING the behavior intact. Maybe it’s the only way you know how to release your own emotions and it feels like your feelings won’t settle until you let them out in this way. Maybe you hold a fear that if you don’t yell at someone they won’t change, and so it feels (on some level) like this is the only way someone can “learn their lesson”. Maybe when you snap and yell it’s actually a way you regain control, since everyone else’s behavior instantly stops. If you can work through the ways in which you actually feel safe, protected, and in control by snapping and then work to find other ways to feel safe and in control in those moments without the snapping behavior the snapping will be much easier to change. This may mean working on decreasing your reliance on the control you feel when your anger erupts.
Example: You’ve gotten into a pattern of cheating on a spouse or partner. You feel terrible because you believe in monogamy but you find yourself again and again drawn towards someone outside of your relationship. It may be time to consider what you DO gain either from the person, how the person makes you feel, the outside relationship, or the experience of courting someone. Maybe there is something enlivening in the risk taking, maybe it helps you feel attractive in a way you haven’t for sometime, maybe you find yourself more able to be honest with a stranger than with your partner and you crave that ability to be honest in your life. You may need to work to find ways to incorporate those positives into your life and / or your relationship. If you can give yourself permission to explore what you are gaining by the behavior and the relationship(s) it will be much easier to change the pattern(s).
Example: You find yourself in a pattern of getting overwhelmed with obligations or responsibilities. You feel like you can’t say no to things because you feel guilty when you do, but time and again you find yourself burned out. As much as you try and set more boundaries you can’t seem to and the cycle repeats again and again. It may be time to consider what the secondary gains are here. Maybe you actually feel proud of yourself for being able to “manage so much”, and maybe it boosts your self-esteem to “get so much done”. You may also enjoy telling others or telling yourself about the list of accomplishments, and you may also feel like “this is what is means to be a good friend / family member / colleague etc”. So despite your burnout and misery, you may not be able to make the change without first finding other self-esteem boosting experiences and without working through this concept you’ve held onto about what it means to be a good support to others.
Example: You’ve fallen into patterns of helplessness in relationships. You ask for things before trying for yourself more often than not and its hurting relationships in your life. This may become hard to change if there are secondary gains to the helplessness. Perhaps you take comfort in people stepping in to help you, perhaps its how you reassure yourself that you’re not alone. It may be a way in which you feel powerful or in control by asking something of others and having them provide. You may feel scared of failure if you were to try doing things more independently and while you know this tends to rub people the wrong way and hurt your relationships, you don’t feel you can let go of the pattern. Facing how this way of being benefits you, and working to build in those benefits in other areas of your life will make it much easier to change the behavior.
Secondary gains are not the only barriers to making changes. See this post on “how change happens” for more help understanding barriers to change.

June 23, 2021March 27, 2023

American Insurance Networks

American Insurance is incredibly complicated, but understanding it empowers you and can save you thousands in your physical and mental health care
I do all of my own billing, and while I’m not an insurance broker I know a lot about common pitfalls that leave people confused and on the hook with surprise costs.
This multi-part series will break down this complicated system so you can get the most out of your benefits, access the care you need, and keep you as protected as possible from unexpected costs
Starting Broad. In the insurance world providers are divided into two categories: In Network and Out of Network. All plans have “in-network” and some plans have “out of network” benefits and they are most often different. Usually it costs you less to see someone in network, BUT depending on the plan some have excellent benefits in both categories
In Network:
- The total amount a provider is paid per session is determined by the insurance company
- How much you as a client pays is determined by the insurance company
- Be on the lookout for carve outs! See post for details
Out of Network:
- The total amount the provider is paid is determined by the PROVIDER.
- If your insurance plan has out of network benefits insurance may chip in none, some, or all of the cost depending on the specifics of your plan
- Some providers are willing to send these sessions to insurance to help you save money. Some are not. Ask your provider.
Both in-work and out of network:
- When using insurance know that your insurance company collects information about you to determine whether or not they consider this a “valid” use of the medical treatment provided. To cover a mental health session they always require a diagnosis.
Yes. If you are in therapy and you or your therapist are sending claims to insurance this means you have a diagnosis. You have every right to ask what that diagnosis is, and to understand what symptoms your provider sees in you that led them to making that diagnosis.
If you want to know costs in advance of scheduling with a provider you can ask the provider if they are in or out of network, and you can contact your insurance company to verify. You can also contact your insurance company and ask what you should expect your “out of pocket” (i.e. your personal) costs should be.
When calling insurance you can provide the CPT codes (these are billing codes providers use) to get exact dollar amounts:
- Initial appointment is often: 90791
- Additional appointments are often: 90837, 90834, and 90832 for individual work or 90847 and 90846 for family / couples work

One major barrier to treatment in the United States – our incredibly complex insurance system.

Insurance networks have two categories: Providers that are in -network and providers that are out-of-network.

Some key differences:

A provider who is IN network is a provider who has signed a contract and agreed to set of rules for how to operate their practice.

How this effects you: This means the provider has agreed to accept fees at a certain rate for the treatment they provide. This usually means the provider is responsible for billing the insurance company on your behalf.

Example (with made up numbers): I say my fee for therapy is $150/hour. The insurance company says to be in our network you have to agree to be paid $100/hour. I can decide to accept that, try to bargain for a higher rate, or decide not to be in network, but once I decide I am “in the network” I have to agree to accept the rate the insurance company and I agreed to for every client I see who has that insurance.

Things that make In-network more complicated:

(1) There is a thing called “carve outs”. This is when you have a plan from one insurance company but they “carve out” a particular kind of health care to another insurance company. I.e. it says “Insurance A” on your card, but ACTUALLY your mental health benefits are through “Insurance company B”. The only way to know if this is the case with you plan is to call and ask before billing happens.

(2) Insurance companies can decide change how much they pay providers. Which means your costs can change even if your plan doesn’t.

A provider who is OUT of network has decided not to sign a contact with an insurance company. Those providers set their own fees, which means the insurance company has no say over how much you will pay per session.

Example continued: I say my fee is $150. You pay me $150. The insurance company doesn’t have any say over it.

At the end of the day, you are responsible for the cost of your healthcare, so be your own advocate, protect your finances, and call your insurance company to make sure you understand what they will cover and what they won’t.

Notes:

I’m quite serious that knowing and understanding how insurance works can save you huge amounts of money. I can’t tell you how many times claims have been processed in a manner inconsistent with how I or my clients have understood their plans to work – and understanding this system has enabled both me and them to challenge an insurance company to have payments made where they were previously denied.
If you’re going to call an insurance company to check on costs, ask for a confirmation number at the end of the call ad write down / keep that number. If there is as issue down the road they will be able to find record of your call when you supply that confirmation number – which may be the “evidence” that you need to get the company to operate in a manner consistent with what they told you at that time (and yes, I have seen this happen many times before).
In Illinois we have something called the “Illinois Dept of Insurance”. I am guessing other states have it too if you want to dig around a bit. This is a government agency that investigates fraudulent uses of insurance by both providers and by insurance companies. If you are spinning because you know something isn’t right with how payment or insurance is being handled this free service will step in on your behalf and investigate. Don’t be afraid to file a claim, I’ve filed half a dozen or so over my last 10 years in business and it works. Sometimes we all need an outside advocate. https://mc.insurance.illinois.gov/messagecenter.nsf

June 14, 2021March 27, 2023

Acceptance

Sometimes the reality we want or believe “should” exist is not the reality that’s in front of us
When we don’t want or can’t accept something we can fight it by hiding from it, pushing it away, denying it, or actively resisting it
This applies to our external reality (including facts about our family, our culture, our country, our jobs, and our lives)
It also applies to our internal reality, including thoughts / feelings we may not like or want to be there, and thoughts / feelings others tell us we “shouldn’t” have.
When we are stuck in the place of non-acceptance, we are in a no-mans-land of desperation, anxiety, resistance without traction, refusal, and misery where we are trying to control, change, and prevent something that already is.
For many of us, the fixation on the reality we wish were true is a distraction – a way to shield ourselves from the pain, shame, embarrassment, loss, or disappointment that would come if we conceded to what the reality in front of us was telling us about our lives or the situation we were in.
When we accept the reality in front of us we can still work towards changing that reality. When we accept we don’t have to approve, or condone.
With acceptance we acknowledge what IS and from that baseline we can make changes in our lives, relationships, or the world around us – rather than being caught in the in-between of what is true vs what we wish or want to be true.
Sometimes the most important thing for us to accept is that we don’t have the power or authority to make or prevent a change we are not comfortable with. When we accept that reality we can begin to refocus on items we do have control over and pursue what is meaningful to us in other ways.
If you have found yourself “cycling”, unable to stop thinking about something, or in a pattern of repetition in your life consider that you may be resisting accepting the reality of something in front of you.

A lot of the distress in our lives is driven by our struggles to acknowledge and accept a reality we do not like or approve of. A “this can’t be happening” mentality can consume us, and efforts to “make it right” or “not let it happen” can preoccupy us. We can just refuse to put up with it as though digging our heels in and not accepting something changes it from being real or true.

As Bessel Van Der Kolk writes of his training, “The greatest sources of our suffering are the lies we tell ourselves’ …be honest with ourselves about every facet of our own experience…people can’t get better without knowing what they know and feeling what they feel”. Our refusal to accept the situation at hand (which includes realities in both our internal and external worlds) creates the suffering Van Der Kolk writes about; we are miserably stuck in-between what we wish to be true and what is. This is when we can get stuck doing the same things over and over – wanting a different result, but not getting one.

We can then be given advice that may not sit right with us, which is to “accept” the situation at hand. For many of us the term accept has associations of approval tied to it, “if I accept it, that means I am saying it’s ok”. So we push aside that advice and continue on in our state of limbo where on the one side we have the reality we wish were true, and on the other side we have the reality that actually is.

If the term “accept” doesn’t sit well with you try concepts like acknowledge, recognize, or observe. When we acknowledge what is happening, we recognize the reality in front of us without condoning or approving of it. We don’t have to like it, but until we can acknowledge it for what it is we can’t start making changes that make us happier, or make our lives or our world better.

For nearly all of us, once we reach that point of acceptance or acknowledgement of what “IS”, a huge burden of distress is lifted. We can be left with loss, pain, and other difficult feelings, but feelings can be resolved, unlike the constant cycling of refusal, desperation, anxiety, and resistance that can stay with us when we are not recognizing and accepting the reality in front of us.

Notes:

Sample statements that can help move you towards radical acceptance / acknowledgement; “this is just what is happening right now”; “I don’t like it, I don’t approve of it, but it is the reality in front of me”; “I want to work to change it, because I’m not ok with it, but I accept this is what is happening and I will do what’s in my power to work towards creating a different reality”.
This post describes radical acceptance as outlined in Marsha Linehan’s‘s skills training manual on pages 176 and 102 Full citation: Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.
The quote is from pages 27-28 of “the body keeps the score”. Full citation: Van, . K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.

June 14, 2021March 27, 2023

Why Meditation

We can work towards having control over our inner world by increasing our ability to control what we pay attention to
For many of us a powerful thought, reaction, or feeling can arise and completely take us over
This is often disruptive, exhausting, and time consuming. We can feel like the thought or feeling is in control of us.
We can dramatically increase our ability to take the intensity out of our thoughts and feelings which gives us more control over our inner experience, actions, and reactions
To do this, we want work to control what we pay attention to, rather than trying to control what comes up for us.
With meditation we can strengthen our ability to select where we place our attention and energy, rather than having our thoughts or feelings decide for us
We can also learn to tolerate our thoughts and feelings without having intense reactions to them
This is NOT learning to “block” feelings, experiences, or thoughts by “tuning them out”.
This is also NOT sitting with a blank mind or a relaxation exercise.
There will be more instruction to come on how to do this, but the goal is to increase your ability to have thoughts, feelings, and take in experiences while still remaining in the driver’s seat of your life.

We can’t control what happens to us, and “what happens to us” includes our thoughts and feelings. We can develop strategies for how to manage them, but ultimately the thought or feeling that arises for us is as much out of our control as the actions of the person down the street.

One of the most powerful things we can learn to do to help us manage our mental health is to strengthen our ability to control where we place our attention, and to increase our ability to tolerate our thoughts and feelings. The more skilled we are at this, the better we are able to manage difficult internal thoughts and feelings when they arise, and the more control we can have over our actions and reactions.

Most of us do not have an intentional relationship with our internal world. We feel a strong emotion, or have a strong reaction and that takes over our attention. Our internal world can then distract us from our external world – making it difficult to focus on an activity, project, person, or event.

There will always be overwhelming moments in life. Most of us can’t learn to take all the power and intensity out of those moments, even with meditation. Sometimes, we will still be distracted by intensity in our internal world, or events that disturb us in our lives. However, we can dramatically reduce our susceptibility to the intensity of these experiences by increasing our ability to control where we place our attention.

With meditation we learn to develop a spotlight around whatever we’ve chosen to focus our attention on. Like a spotlight, the stronger our ability to control our attention, the more we can focus on what we’ve chosen to focus on, and the less energy and attention is given to what we’ve chosen not to pay attention to.

The specific skill that I’ve seen enable many of my clients (and others) is a particular kind of meditation where we are working on observing our thoughts, feelings, and sensations without reacting to them. This skill, like a muscle, requires practice. The good news is it can take as little as 30 seconds a day for you to dramatically increase your ability to control your attention.

Future post to cover HOW to do this.

Notes:

1`. Chelsea Handler’s book, life will be the death of me, covers her journey through therapy and how her use of mindfulness (and therapy) changed her life.

2. I want to be clear: meditation is not intended to numb you, or desensitize you from painful experiences in your life or events in your community. We are not sticking our heads in the sand and “ignoring”. When we control our attention the goal is not to “block things out” (that would be avoidance). There will be more posts to come on how to do this!

3. Jon Kabat-Zinn ‘s book “wherever you go there you are” is an excellent introduction into mindfulness and meditation

June 4, 2021March 27, 2023

Tolerating Trauma

Sometimes the most tragic of stories are the ones we have a hard time finding empathy for.
Instead, we can create distance from the story, person, or situation by finding ways it couldn’t happen to us, in our lives, or in our community.
Sometimes that can look like denying it could happen to or near us.
Other times we create a narrative about how the person participated in creating their painful experience
Something like: “if they had lived their lives differently, more carefully, this wouldn’t have happened to them, and so I can feel secure that this won’t happen in my life because I would be careful in ways they were not”
This is a natural response; we are trying to keep our sense of safety in the world as we know it intact.
While natural and often automatic, it is important that we own it as OUR response to OUR sense of vulnerability and OUR fears that this could happen to us.
Too often, how someone may or may not have participated in the outcome of their situation becomes the focus of the conversation with and about people who have experienced something terrible
While accountability, when due, is an important part of prevention moving forward, we can be tempted to hold someone TOO accountable for their tragedy as a way to help ourselves feel safer in our lives.
There are unfortunate consequences to this style of coping by distancing for all parties. Learn more about the impact of this in today’s post.

Have you ever found yourself hearing a story about something horrible that happened to someone, only to find yourself distracted by your internal effort to look for a reason that couldn’t happen to you or in your life?

Some version of “this wouldn’t happen to me because I live my life in a such a way where I am protected from the possibility of this horrible thing happening here, to my family, or to me”.

Examples include: “My child couldn’t drown in a pool, I would have a gate up.”

“I would never be out that late in that place”

In those moments we are doing something very natural, which is trying to keep our sense of security in our world intact after hearing a story that leaves us feeling profoundly unsafe.
As Bessel Van Der Kolk writes, “We all want to live in a world that is safe, manageable, and predictable, and victims remind us that this is not always the case”.

It is natural for us to want to feel safe in our lives, and having these protective thoughts is ok – and for many of us very automatic. It is important, however, that we recognize when we think in this way it is a response to our sense of vulnerability and our fears that our lives could be shattered in the way we are hearing about.

If we don’t recognize this is OUR protective mechanism, rather than an objective reflection on the situation, there can unfortunate consequences to you, the person sharing their struggle, and your relationship with that person.

If the focus of our response is on how safety could have been preserved if they acted differently we leave a person whose sense of safety has been shattered feeling isolated, and at times ashamed or like the outcome is entirely their fault*.

We can, in an effort to hold on to our sense of safety and order, develop blindspots about threats in our community that could impact someone more vulnerable than us, and eventually us.

Responding in this way to someone’s vulnerability when they share their story shuts off your vulnerability from you AND from them, creating disconnection.

There is no one “the right” way to respond in these situations, but be on the lookout for your own need to feel safe interfering with you ability to hear someone else’s pain or story.

Notes:

Quote is from page 196 of the Body Keeps the Score by Bessel Van Der Kolk. Full citation: van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
*I do not mean to undermine the importance of accountability when it is due. Instead, I want us as the listener to be on the lookout for our desire to find a way that this couldn’t happen to us. Sometimes we have trouble accepting that someone may truly just be a victim and some times terrible things happen despite reasonable efforts to prevent them.
It is not your job (unless you are a therapist) to tolerate hearing all the gory details of someone’s traumatic situation. Instead be mindful of your own protective mechanisms when someone is being vulnerable with you and sharing their difficulties. It is always ok to hold a boundary around what you feel able to hear and when you feel able to hear it.

May 31, 2021March 27, 2023

Emotional Blocking

Our emotions continue to effect us even if we don’t perceive them
Even if we don’t feel or notice our feelings they can still have a major impact on how we process the world around us
Some of us believe our emotions don’t influence us, and we are ruled only by logic or reason
Some of us know we have feelings, but they slip away and escape us before we can really make sense of them
This post is for those of you who feel like your emotions are far away or hard to hold on to. There will be posts to come to help you sustainably get in touch with your inner world
To get better at noticing, feeling, and making sense of our emotions we need to learn how to turn the volume up on our feelings in a way that doesn’t overwhelm us, but has emotions stick around long enough for us to make use of them.
Emotions are complex, but they involve brain and body changes in a feedback loop. We can learn to tap into that feedback loop to help us be in better touch with our feelings
For those of us that have a hard time registering what we are feeling starting with our bodies is often the more accessible entry point.
Each feeling has combination of body sensations and brain changes that make it distinct. We can learn to pay attention to those body changes and stay present with them as a way to help us connect more to our emotional world.
Remember: if something feels like too much, return to grounding skills.

Thus far I have written a lot about feeling overwhelmed by emotion, the times when we are filled to the brim or feel like we are bursting. For many of us, however, we have the opposite relationship with our emotions, we struggle with not being able to hold on to our feelings; they slip our of reach, or just aren’t there.

At times, it’s not an intentional pushing down or away, it’s just what happens, like the feelings don’t ever really seem to bubble up. Other times it may be more intentional. Some of us have come to believe that emotions are a waste of time, or we we’ve trained ourselves “not to have them” and consider ourselves to be ruled solely by logic and reasoning.

As Daniel Seigel writes, there are consequences to this non-experience of emotions too, “When we block our awareness of our feelings, they continue to affect us anyway. Research has repeatedly shown that neural input from the internal world of the body and emotion influences our reasoning and our decision making. Even facial expressions we’re not aware of…directly affect how we feel and so how we perceive the world.”

In short, what Dr. Seigel writes is that even if we don’t notice our feelings are there, they are. Even though we aren’t conscious of them, they impact us, our decision making, and how we perceive what’s going on around us.

So, for these folks, we want to help you learn how to turn the volume up on emotions in a sustainable way. For that to happen, we need to help you tolerate the experience of your emotions, which have probably been whittled down because at one point they were too painful, or perhaps you came from an environment where they were not welcome.

We can help you increase your ability to notice your internal world by helping you work to be more connected to your body. Emotions are complex, but they involve brain and body changes in a type of feedback loop. We want to help you plug into that feedback loop by being more present with your body. That way we can help you work to notice and gradually hold on to the emotional signals within you.

There will be more on how to do this, but keep your eyes peeled for mindfulness and body based posts to come.

Notes:

The Daniel Siegel quote comes from his book, Mindsight. (page 125). Full Citation: Siegel, Daniel J., Mindsight : The New Science of Personal Transformation. New York: Bantam Books, 2010.
The theory of emotions (the part about emotions being a feedback loop that involve brain and body changes) is a brief summary of what is laid out on pages 87 – 88 and page 137 of Marsha Linehan’s DBT manual. Full Citation: Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
If you are eager to start working on increasing your awareness of your emotional world run yourself through the exercise of taking some core emotions (anger, sadness, fear, joy, confusion), and sit quietly. Work to pay attention to what happens in your body as you bring up a memory that includes each emotion. Each emotion has a distinct feeling experience in our bodies, and we want to become aware of how those feelings manifest in each of us. Knowing “what” they feel like and “how” it feels in our bodies, and being able to tolerate that feeling helps us become more able to identify and tolerate emotions as they come up naturally in our lives. Be sure you have mastered grounding skills before trying this, it may be overwhelming to start “turning up the volume”. If so, consider starting only with emotions that are more tolerable to feel and get to the more difficult ones once you’re comfortable there.
Wondering why on earth you’d want to feel your feelings – especially your negative ones? Read this post about how are emotions are like “traffic signals” in our inner world .

May 26, 2021March 27, 2023

How to Ground

Grounding skills are the “reset” button for our brain
Many of us avoid our feelings because they are too overwhelming for us to handle
When feelings are too much they can overload us (fill us to the brim and consume us), or numb us (leaving us with nothingness, tired, unable to focus)
When we can effectively use grounding skills we know how to bring ourselves back from those moments
Having this ability to bring ourselves back makes our emotions much less scary – because we know we can always hit “reset” if needed.
These can be done ANYTIME, including when you are around other people and they don’t ever have to know you’re doing it. They can take as little as 20-60 seconds.
For grounding skills to work it is ESSENTIAL that you 1) Engage your senses 2) Engage your whole self (which means no thinking about the thing that’s going on while doing it!) and 3) are mindful of keeping yourself and others safe
Nearly every time I introduce these to a client they roll their eyes at me and ask me if I’m kidding. I am not kidding. This really works. Try it and see for yourself.
The skill I have seen that is most effective is counting a particular classification of objects in a room (i.e. how many circular objects do you see, how many green items are in the room, how many places where you could set something down)
I consider grounding skills to be essential prerequisites for intensive psychotherapy. For us to face our painful emotions we need to have the skills (and to confidence) to come back from them.
There are thousands of grounding skills. Learn more in today’s post.

Grounding skills are essential “bail out tools” for the mind. These are the life raft, oxygen mask, parachute of the brain – essential for helping us “come back to the ground” when our internal world is more intense than we know how to handle (when we are outside our window of tolerance.

These are skills we want to keep in our back pocket at all times, and I encourage my clients to use them in low stress scenarios before relying on them in high stress scenarios so that they get used to what it feels like to “bring themselves back online”.

There are thousands of grounding skills, and you can even make them up can work as long as they meets some basic criteria: 1. Engages your senses 2. You commit yourself with ALL your attention and capacity at that moment 3. Does not have the potential to cause harm to you or others 4. is done at a time when your safety is not threatened. If your physical safety is threatened you need to get to a safe place first. Grounding can help you find emotional safety.

Despite being simple (almost laughably simple) these exercises are often powerful IF we follow the criteria listed above. I find the biggest pitfall is not following criteria 2 – it is essential that we not multi-task and think about something else, we have to bring our brain back to exercise again and again if it veers away. It will be natural for it to veer away, just keep coming back to the task. I also find it helps to keep it simple – if counting works for you (it’s my favorite), rely on counting, and keep counting different types of things in the space around you until the intensity has dissipated.

Grounding exercises work because they engage a different part of our brain AWAY from our emotional center (which is overloaded prior to grounding). These exercises also force us to come back to the present, which is often not as threatening as our internal world.
Examples of other grounding exercises in the comments, you can also search the internet for lists of these.

Notes:

Grounding Exercise: Visual. Counting a particular classification of objects in a room: How many circular objects do you see, how many green items are in the room, how many metallic items, how many places where you could set something down, how many soft items, how many hard items. The list goes on and on. This one is excellent for doing discreetly.
Grounding Exercise: Touch based: While in place, scan through your body and notice every part of your body that is touching something other than air. Notice how it all feels on your skin. Notice the pressure of where your weight is, the feeling of fabric on your skin etc. Experiment with pressing into what you are touching. Count how many different items your body is in contact with. This one is excellent for doing discreetly. This grounding skill might be challenging for someone struggling with body image concerns.
Grounding exercise: Touch, smell, sight, sound. Shower with fragrant (and different than usual) scented cleansing products. Notice the temperature difference between the water and your body. Showers can be very powerful, but this is obviously not one you can do in place.
Grounding exercise: Smell. Put on a lotion or perfume. Smell it and see if you can pick out the different scents in it. How many can you identify. This can be done discreetly, but does require keeping something scented with you which might be a barrier for some.
Grounding Exercise: Taste and touch If you have a liquid with you put it in your mouth and hold it before swallowing (be mindful of not doing something that causes pain – aka – make sure it’s not too hot!). Notice the temperature change. Notice any tastes. See if you can classify them.
Grounding exercise: Hold an ice cube. This one is awesome because it is very hard to think about anything else while you are holding an ice cube. What I don’t like about it is that it a) requires you have access to ice b) requires you move from where you are – which you may not feel motivated to do in the throes of emotion and c) leaves you wet which can be annoying and something that deters you from doing it. I like to think about this one as one to try when you’ve tried some internal ones as those aren’t working as well as you’d like
Grounding exercise: If you search the internet you’ll find this one: identify 5 things you see, 4 things you feel, 3 things you hear, 2 things you smell and 1 thing you taste. This is great because it really engages all your sense and is very powerful at bringing you back because of how much focus it requires of your brain. What I don’t like about it is that it might be hard to remember in the moment, and it might be frustrating if you can’t smell or hear anything at the moment.
All of this sound totally ridiculous? Check out why we need Distress Tolerance skills.
See more about how to gradually incorporate a skill in my post on How Change Happens.
Are you finding you need to ground often? I’d encourage you to consider one on one therapy to help.

May 26, 2021March 27, 2023

Controlling our Attention

We can’t control what happens to us. What happens to us includes events, but it also includes our thoughts and our feelings
Many of us experience inner anguish because we have trouble accepting that what we think and feel is not actually within our control.
We feel what we feel, we think what we think and the best way to insulate ourselves from tough times is work to build coping skills that help us live in harmony with our inability to have the inner world we believe (or have been told) we “should” have.
We can use meditation and mindfulness based skills to help us detach from the intensity of our thoughts and feelings. While we can’t control what happens, these skills help us increase our control over what we pay attention to.
We can use emotion regulation skills that help us to “turn down the dial” on emotions when they are intense, but not at their most powerful.
When emotions are their most intense we can use distress tolerance skills to help us get through a situation without responding to them in a way that will create a problem for us further down the road.
This account will help you learn skills in all three of these categories, and work to help you build awareness of when it makes sense to use which kind of skill.
These skills help us manage pain when it arises in a way that won’t create further suffering for us, and will help protect our relationships and get us through with as little suffering as possible.
No one manages their thoughts and feelings ideally 100% of the time. That is not possible. We are all human. The goal is to help you have the skills so that you know what to do, aren’t so lost in those moments, and can get through them with as little suffering as possible.

One of the things we therapists know, and we work to help our clients accept, is that coping is about learning and accepting what we can and can’t control. We can’t completely control what happens to us, our thoughts and our feelings.

Many of us have luck for sometime pushing thoughts and feelings down or away. We also can organize our lives in such a way that we can have some control over what happens in it, though that’s more often possible when we have more resources. Regardless, at best we only have some control, and we don’t have the level of control many of us wish we did.

I want to be clear: pushing feelings or thoughts down or away isn’t bad. It’s a skill. A skill that works some of the time. However, if we only rely on that particular skill for coping with our internal world we are not equipped for very difficult times, or for when a tidal wave of thoughts or feelings comes in. Further, we lose our ability to learn from our feelings if we rely too heavily on pushing them away.

So, we all need to have a broad array of coping skills. Think of them like tools in a tool belt, different skills for different scenarios.

Instead of trying to control what happens to us, our thoughts, or our feeling we can work to increase our ability to control what we pay attention to and to detach from the intensity of what we may be feeling or thinking. This can be done through meditation and mindfulness based work.

Sometimes we need to learn how to lower intense feelings, that’s called emotion regulation. We use emotion regulation skills when we feel emotions on a level where they “need some wrangling” (i.e. they aren’t dissipating on their own), but not when they are at their most powerful.

When our feelings are really intense, and emotion regulation skills don’t work we can learn to ride them out, let them peter off, distract, or soothe ourselves through distress tolerance skills. With these skills we are working on introducing new and different focal points to divert our attention for a period of time. We are not solving or changing, we are getting through and in doing so helping our brains “reset” so we can tackle the issue when our feelings are not as intense.

Notes:

This post outlines three of the fours modules in Dialectical Behavior Therapy’s skill’s training program. For more information Full Citation: Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Pushing thoughts and feelings down or away, as mentioned in the post, is a distress tolerance skill. It is a powerful tool to use when our emotions are too overwhelming for us to face, or when the scenario we are in requires we move forward rather than address our experience. For more on why we need distress tolerance skills see the argument for distress tolerance. As with ANY distress tolerance skill we want to return to the topic at hand once we are available to face it (i.e. the scenario allows it, and our internal world feels more balanced).
We use emotion regulation skills when we are still in our window of tolerance, but nearing the edges of it, or perhaps just outside of it. For information on what our window of tolerance is and what it feels like to be outside of it, see “window of tolerance”.
Another reason it is difficult to control our thoughts and feelings is outlined in the post “your brain as an association machine“.
Post covering how we can learn from our emotions is called “emotions as traffic signals” .
Unsure if your emotion is dissipating on its own, or if you need to intervene to help? See Emotions are brief.
One thing that feels important to acknowledge: While these skills can help us manage pain they are not the be all end all and it’s not as though these replace the need for therapy or support from others at times. These skills do not turn us into a one person “cope with anything and everything” machine. These skills help us manage pain when it arises in a way that won’t create further suffering for us, and will help protect our relationships and get us through with as little suffering as possible.