Tag Archives: Self-care

Why Ask Me That? Third in a series on questions in the therapy room

Someone who is struggling with anxiety just wants to feel better. It’s understandable; anxiety feels awful. The physical symptoms, so often hovering just below full-blown fight-or-flight; a mind that won’t rest, a brain that hops from topic to topic like a rabbit in a vegetable garden. Add to this the fear that so many people have when they come to therapy:  will the therapist tell me I’m crazy?

No; no, I won’t tell you that, but I am probably going to annoy you with a lot of questions that may seem to be irrelevant to your suffering. My paperwork asks about your history, decade by decade; your losses; job satisfaction; health issues; your alcohol and drug use; your prescribed medications; your exercise and sleep patterns. I ask about screen time, social memberships, supportive relationships. I ask a lot of questions, and I can tell who thinks those questions are irrelevant by who leaves them unanswered, handing me incomplete paperwork and acting surprised when I follow up on the many blank places.

All these questions are important, and here’s a short discussion on just a few aspects and the explanation.

Your sleep patterns, and any difficulties, can both contribute to, and be worsened by, anxiety, stress and depression. If you need more, or better sleep (and most people do), figuring some ways to improve your quality and quantity of sleep can help across many categories of your life: focus, memory, energy, stress level, and mood. When these improve, relationships can often improve, as you might expect when you can pay attention and be less cranky.

If you have major health conditions that are not properly managed, these may contribute to problems with sleep, anxiety, or mood. For example, poorly managed diabetes, besides being physically very dangerous, impacts focus and mood. I would refer you to your physician to see if there are problems that require medical attention.

Social isolation is a recipe for loneliness and depression. Social media use tends to make this worse – something that seems weirdly contradictory. Lonely people eventually withdraw, and this creates more loneliness, isolation and possibly anxiety and depression. We need to explore ways to enter back into activities with others.  From my guidance counselor days: children who are isolated suffer. If you ask a child if s/he has friends, and then ask him/her to name those friends, and there is a flash of hesitation, you know you are dealing with a child suffering social isolation. Just so, adults who cannot identify some supportive relationships and what is good about those relationships is an adult who is emotionally isolated.

I ask questions that make sense to me; if they don’t make sense to you, please ask why I’m asking. Thanks!

Why Ask Me That? Part 1 of a Series on Questions in the Therapy Room

“It’s a lot of paperwork.” 

Yes, I agree, it is. And all that information is helpful and useful for me in what I presume is a shared project: making positive change in some aspect – or many aspects – of that client’s life. 

The number of people who simply skip sections, as if they were optional, or not relevant, is significant. This gives the opportunity to have some conversations about those questions, and their relevance.

For example:

If someone routinely shortchanges their sleep, health problems will develop. In the short term, irritability (which tends to mess up personal and work relationships), less efficient short-term memory (ditto), distractibility (ditto) and impulsivity (mega-ditto) are possible contributors to whatever the primary complaint may be.  So maybe we should address that, too!

If you are extremely extroverted and are working remotely and living alone, you have created a perfect petri dish for restlessness, depression, and dissatisfaction. Those are psychological and emotional factors that create problems across domains. Deliberately arranging adequate real interactions with others will be essential to meeting that basic need.

If you don’t have five or six people who you can identify as part of your social support system, such as friends, family, a mentoring colleague, etc., there may be a heightened risk for depression and anxiety.  That doesn’t mean you confide personal problems with all those folks; you might have someone who provides support and encouragement in career-related areas, some people you can pray with, people who you play sports or exercise with and enjoy lighter conversations.

There are no questions on my paperwork that are not rooted in helping the client and me have a grounded understanding of the client’s strengths, struggles, and emotional resources for making positive change. Just ask me.

Detour Ahead. There. And there.

Look carefully. Yep, that’s a detour sign, pointing to the right at the T-intersection. And yes, across the street is another detour sign, pointing left. There are, as it happens, only two ways to choose here – right or left. Both appear to be detours. To where? From where?

A quarter-mile away, the road crews who neglected to pack up these signs (months have passed) also left behind a Detour sign with an arrow pointed up, as in, go straight ahead. That particular sign has been moved back and forth, one day pointed north, then south, and, most recently, either whimsically or horribly, as if the detour was to crash through someone’s side fence into their backyard.

Pity the unsuspecting rideshare driver who has to figure all this out. Eventually, there will be road work in our area again and we’ll all stupidly ignore the first detour signs, because we’ve learned to regard orange signs with arrows as signifying nothing.

There you go: life with crazy detours and places where there seems to be no right answer. At least, there seems to be no easy answer. It can be hard to know if a detour indicates something to be avoided or a relic or even a ruse.

Anyone new to the neighborhood would be stymied by the mixed messages, while the people who know the origin of the dueling detours shrug and ignore them – or, in some cases, get annoyed and move signs across the street.  There’s a clue: when a detour arises, ask questions; see how other people are responding to the apparent detour, and why.  On occasion, I see, in stores, the relics of the social distancing recommendations of 2020, those half-peeled away stickers on terrazzo floors. Like the road-sign-weary denizens of my area, shoppers ignore signs that used to be treated as if they’d come down from Mount Sinai.

There are detours that make sense, like when there’s a big hole in the road. No doubt you’ve gotten your share of detour signs from life. I’ve had mine. Some have kept me from disaster, and some turned out to be less about danger and more about someone else’s fears or agendas.  I’ve heard about many – and about so many people who figured out which detours were legitimate, and which were either relics or ruses.

Wishing you good adventures, and the wisdom to know relics from ruses, as well as to never be the person who puts up fake detour signs for others.

To Ink or Not to Ink

To ink or not to ink: that is the question.

Not my question, but a lot of people debate this. Perhaps they are considering the latest news: the research showing a significant increase in the risk of blood cancers with just one tattoo. That seems worth attention.

Sometimes, people planning a tattoo want to talk about it, the image and the expected arguments from friends or family. We might discuss the option of wearing a piece of jewelry with the same design for a year straight – no exceptions – or the benefit of a trial run with temporary tattoos for a few months.  Perhaps pulling out a particularly unflattering photo, with a hairstyle and clothing you thought looked great at the time, and facing it every day for a year or so would provide a tap to the brakes. Most often in these conversations, I simply listen, ask a lot of questions, and offer my personal explanation as to “why not.” There are three significant reasons.

On my phone, I have a photo of memorial bricks that rest in Europe, with the names and deportation dates of family members who died in Auschwitz in 1944.  They would have been tattooed by the Nazis, each with a unique number, for the obsessive record-keeping for which the Third Reich was known. Out of respect to their memories, no ink.

I can’t think of any sort of decoration I wouldn’t tire of, sooner, probably, rather than later. A look at my hair and fashion choices in old photos makes that spectacularly clear. Due to the likelihood that I will someday find my décor of the day regrettable, no ink.

Finally, the two most significant factors in my life, my faith and my marriage, are too important to me for tattoos. Both deserve a deliberate, mindful choice – every day, every moment. The crucifix I wear is by choice, never mindlessly or without reverence for its meaning and the demand placed upon me, however poorly I may live out that demand. The wedding ring is deliberate, a clear statement of, I love you, I choose you, each day. Never indifferent, never nonchalant: to wear these things is a daily action verb.

Now, those reasons may make no sense to you. Maybe they seem silly or irrelevant to your situation. Perhaps they do; but perhaps they are worth a conversation with someone as you, or they, make decisions about permanent records of this particular spot in place and time.  

What’s in your backpack?

I was speaking with someone reluctant to make any sort of commitment to a small change in the routine. Things were not going well for my friend, and the future seemed murky. With no clear picture of “where the journey is heading,” taking any first step seemed imprudent, my partner in conversation asserted; it would be better to wait until the “where” is sorted out in life before making a concerted effort in any direction.

One reasonable response to that is, there is no “standing still” in life: attempting to stand still just means things around you will change while you pretend you can hold your position.  See how that works for you standing in the ocean. Maybe that seems trite; the whole “you never step into the same river twice” trope that is, as it happens, absolutely true.

Another way of looking at my friend’s dilemma is this: no matter where my journey is going, some items always go in the backpack. I may not always need the water purification straws, or the sleeping bag rated for freezing weather, but I always need underwear and socks. I always need a spare pair of contact lenses and sunscreen. I always need a small Bible. I always need chocolate and my thyroid medicine. Even without knowing where, or when, I’m going, some things can go into the backpack.

No matter where your life journey is taking you, wouldn’t it be helpful to have a better quality of sleep? More physical energy?  A firmer sense of what your values are, and why, and what the implications are for daily life? A little less messiness in the closet or refrigerator or your car? Less weird clutter and mysterious crumpled papers in that one drawer? Some better thinking habits, whether it’s taking on a phobia or developing your capacity for focused attention?

Even if you’re feeling really stuck – a lot of pressures, an unhappy job situation, the first year or so into significant grief – perhaps there is one small thing you can do first– something you can “put into the backpack” – without a clear picture of where you hope to be heading. And, as you’re putting those essentials into your pack, perhaps the mystery of the next few steps on the journey will begin to come into focus.

Happy trails –

For Those Mourning a suicide

If you have lost someone to suicide, my sincere condolences:  peace be upon you in these incredibly difficult times.

I have been involved in grief counseling for a long time. I began volunteering as a grief support group facilitator about 20 years ago. Grief is always painful – the Irish language word clumsily translated into English as “Troubles” actually means tearing apart.  Losing someone to suicide is definitely a tearing apart, and one that carries particular burdens.

  • They are even more likely than other mourners to look backwards and try to reinterpret events to make sense of what happened. We humans like for things to “make sense,” even things that can’t be understood. Looking back can lead to a lot of unnecessary suffering – self-blame, recrimination, guilt.  Our culture pretends we can control just about everything, but we cannot. Through the lens of grief looking backwards, even a passing sad day years before can seem like a sign that was “missed,” and the perfectly normal little disagreement turns into the possible cause. Every memory is scoured for warning signs. The lists of warning sides of suicidality are helpful, but not all people have them. In reality, about 70% of suicides are impulsive acts – there are no real warning signs or markers, beyond the events of life that many people experience without becoming suicidal:  relationship struggles, financial struggles, legal struggles, job loss.  Some people will show some of the warning signs but are not be suicidal at all, such as someone who is enthusiastically minimizing their possessions in order to downsize. Please try to refocus on something else, even a small physical task, when you find yourself looking back to try to see what you “should have” seen: you are at risk of burdening yourself with unnecessary guilt.
  • Those whose loved one committed suicide are likely to hear even more of the hurtful things people can say to those grieving. Granted, most people’s hurtful remarks to mourners are well-intentioned, and yet incredibly unhelpful, such as the dreadful, “You’re still young…you’ll have other children,” or, “You should be glad they’re not suffering any longer.”  There are some people, though, who say truly, intentionally horrible things about those who commit or attempt suicide, and this leads mourners to lie about the cause of death and/or isolate from others.  Avoid these people; seek the company of those who are compassionate.
  • Those who have lost someone to suicide are especially likely to avoid going to grief support groups, or will only go to those about suicide.  I encourage going to a general grief support group, too; it can be a place to learn a lot of skills and strategies that are helpful to all mourners, and can be that first, safe place to talk about what really happened and get support as you manage the tangle of terrible emotions. You will find strategies and support for how to take one step at a time into a world that seems to no longer make sense. Please do not isolate out of pain, unnecessary shame or unnecessary guilt.
  • See your primary care doctor, avoid any mind-altering substances, and try your best to follow medical guidance – even though you will often not feel like eating right or exercising.
  • Seek individual or family counseling to help with the grief process as needed.

And, of course, as this is not psychological guidance or advice – just information and encouragement – reach out for help if you are struggling with suicidal thoughts or fear for someone else. Besides your health care provider, the local emergency room, or 911, you might call the National Suicide Hotline at 988 or the 1-800-273-TALK (8255) National Mental Health Hotline.

If you are reading this and thinking of someone you know who has lost someone to suicide, please reach out with compassion. Be present; keep reaching out. Invite for simple things; offer specific help (with chores, for companionship, to go with them to a grief support group because going is, at first, absolutely terrifying). Please do not ask a lot of questions about the death; if the person is open, instead ask about the person: the happy memories of the past. Ask if you can help and don’t be surprised if you hear, “I’m fine,” or, “You can’t bring them back,” or, “I don’t need anything.”  In that case, come back another time with specific offers (“Can I come by sometime and help with the lawn?” “Are you up for a cup of coffee at the park?” etc.).  Be gentle with people who have been torn apart.

Thanks for reading.

Christmas all year ’round

‘Tis the season.  My Christmas tree is still up – it is, after all, still Christmas time. This is not a diatribe about people who tear down Christmas before the turkey or ham is cold; I understand that for many people, this holiday season was terrible, a time when loss was rubbed into their face. For them, simply going through the motions of the holiday was an act of profound and sustained moral courage.

No, I am reflecting on the reminders of Christmas that will be up in my home all year.  This is not new, and not unique. It reflects the profound Incarnation, and the love and hope that flow from that.  The little clay Holy Family we bought in San Antonio sits on a shelf beside the front door: it is more than a souvenir and more than the gratification of seeing Jesus, Mary and Joseph with skin closer to Semitic tan than impossibly pale, northwestern European.  It is, most of all, a reminder that the Eternal Word who “When He fixed the foundations of the earth, I was beside Him as artisan; I was His delight day by day, playing before Him all the while, playing over the whole of His earth, and having delight with human beings,” (Proverbs 8:29-31) came among us in, reminding of us the dignity of life even in that humility and weakness.

And as the year rolls on, and the oppressiveness of world events bears down on us, we need a star. Without remembering, deliberately and meditatively, the implications of the inexplicable event we celebrate at Christmas, the darkness can seem to be winning, and yet, “The Light shines in the darkness, and the darkness has not overcome it.” (John, 1:5). Looking at the news, it seems unlikely that things are apt to improve out there anytime soon. And so, as always, I am prepared for the annual summer revival, stirring afresh the wonder of the Incarnation. Sometime in July, when the heat of summer seems to have made the world even angrier, a hidden bag of peppermint bark will emerge, and Christmas music will be played, loudly, in defiance of what seems to be ever-growing darkness.

It is particular Christmas music: starting, necessarily, with Mannheim Steamroller’s “Deck the Halls.” If you know the performance, you understand. If not, it bears some explanation. This is no “ho, ho, ho” or “jingle those bells” type of “Deck the Halls.” It is the tune as it is meant to be played: the triumphant preparation for the arrival of the King, a blast of victorious celebration. It could be the sound of the creatures of Narnia preparing for Aslan’s conquering return. It is a song that, when Steamroller opens with it, has the crowd standing and cheering – to the apparent amazement of the musicians.

If it sounds as if it could be helpful, this summer, when the city streets are on fire and the news cycle is bleak, have a bit of Incarnational reawakening. Leave a reminder of Christmas out all year.  Play some music to stir your soul, and remember that, “The Word became flesh and made His dwelling among us.” (John 1:14).

What’s up with that?

Why do you do what you do?

No, seriously. Why do you do what you do, whatever it is that you do?

Could you get a bit obsessive about this question? I suppose so. But it is worth asking, over and over again.

You got out of bed at whatever time it was. Why? For what purpose?

Why did you eat and drink what you ate and drank? Or, why did you choose not to eat?

What did you put on your body to wear out into the world, to tell other people about you, your tastes, and your intentions?  Why those messages, and not some other messages? Why are those the messages you choose to give to the world?

Why did you go to work? Why did you choose that work?

Why did you behave that way, and not some other way, towards whatever persons you encountered along the way?

Why, why, why, why.  Sometimes it is important to take a step back and ask that defense-raising question of yourself, repeatedly, digging in.

Well, why, you might ask, and it is a worthwhile question.  Asking ourselves “why” is very important, because, if we drill down far enough, we come down to whether or not we have decided upon a central principle, a guiding ethic, a core belief that allows us to direct our behavior with cohesion and authenticity towards our purpose.  If you don’t have a “why,” you are less focused than the average toddler. A toddler can be remarkably determined in pursuing her goals, despite an inability to clearly articulate the “why” for coloring on the walls or giving Teddy Bear a bath in the toilet. 

For religious people, the central “why” comes down to a covenantal relationship with the Lord and, for Christians, a relationship with Jesus, the Christ.  That is the “why.”

Why get out of bed on time? Because an orderly life (ordered to what is best) requires self-discipline and routine, and honoring one’s legitimate commitments to others.

Why be kind to the barista, the cashier, the slowly shambling person in front of you on the sidewalk? Because they, like you, are a child of God and your rooted relationship with Him requires you to treat others as His children, too.

Why be honest with someone when you know it will be ill-received – the student whose work is apparently plagiarized, the employer asking you to do the unethical, the adult family member who is drinking in excess? Because it is important to be truthful, to not allow dishonesty to muddy the waters of relationships and to let yourself slip into that mud out of fear of conflict. Because your relationship with the Lord requires you to act honestly, justly, and with love.

Wishing you a new year full of the joy of discovering beautiful “why’s” in your life!

Taking it to the mats

What ever happened to giving someone some grace?  Or being tolerant?

As regular readers, I occasionally page through popular magazines just to see what sort of toxins are floating around in the public sphere.  It’s less time-consuming and annoying than hours of screen time. Between what I read, and what I hear from those on the receiving end of what is often cruelty, there is a whole lot less tolerance in these self-referentially oh-so-tolerant times than in the past. Often supposedly tolerant people demand that any disagreement be taken to the mats, verbally if not physically.

To be clear, I am talking about disagreements between people where there is no violence or threat of violence. I am not talking about adopting a “live and let live” attitude about child abuse or elder exploitation or criminal acts. I wonder where tolerance and grace went when it comes to the people we encounter in nonviolent settings in our daily lives.

A simple little example was an advice columnist’s suggestion that dealing with an annoying “friend” who calls during work hours and drains your energy and time with daily drama should comprise a formal sit-down in which you express how their thoughtless behavior impacts your feelings and your work, and expect some sort of mature, measured apology.  I am practical. My guidance would be along these lines: this is your “friend.” Surely you noticed before this that she seemingly has the thoughtlessness and flimsy self-control of a spoiled tween.  You accepted the friendship under those terms; she hasn’t changed. You have. Stop taking calls or looking at texts from her during work. What kind of job allows you to chat with friends on the employer’s dime?  Call her back when it’s convenient. And, if you choose to be friends with her, accept that she is as she is. She will be immature and you will have to set boundaries. Sure, tell her you can’t be interrupted at work. But you and I both know that having a nice little sit-down with her isn’t worth the aggravation. Imagine the flood of drama, spilling and splashing all over the table at the coffee shop.

In families, people disagree. At Thanksgiving, if you are fortunate enough to have family and friends with whom you can gather, people will have differing opinions. At least one of them may have misplaced their tolerance or drowned it in some substance of abuse. What to do? You might have fun arguing. My late cousin George, who had Soviet bullet fragments in his leg from his teenage adventures helping people escape from East Berlin, would take a perspective he didn’t necessarily agree with, for the entertainment of developing and defending a position, and do it with a twinkle in his eye. You might find that stressful; your plan may be to discreetly go do some dishes because “here s/he goes again.”  You might enlist at least one ally in a plan to divert and change topics if the intolerant person who expects everyone else to be tolerant starts pontificating. You might decide to politely express your perspective. Depending on the people present, any of those may be prudent.

Some people implode relationships foolishly. I know people who were cut off on the flimsiest of rationale; because they are “too negative,” or “worry too much.”  People cut off parents because their parents do not “support” (as in overtly cheer and brag about) their adult child’s career choice, tattoos, or other decisions.  And, conversely, parents cut off adult children.  In cases where people are dangerous, or truly disruptive (the addicted adult child who breaks in and steals from the parents; the abusive parent; the family member who is aggressive and belligerent about their cause-du-jour, as examples) then yes, safety and sanity require appropriate distance-setting. This is sad, even when necessary.

I’m not an appeaser or a door mat. When it comes to disagreements, I think that freedom requires that we live and let live in peace (that’s what tolerance used to mean) until the circumstances are such that it is necessary. Necessary means that an expectation for compliance is placed upon me, a demand that I change my mind or pretend to agree with something I find false.  It is necessary when harm is being done, is threatened, or is imminent. That is when it is important to speak up, calmly and rationally, to base my position in fact and refuse to play silly word games. Speak calmly, peacefully, firmly and succinctly, refusing to pretend. That would be a way to “take it to the mats.”

Paraphrasing St. Francis of Assisi – Peace and every good to you.

I could tell you, but you’re not going to like it: Anxious Youth

As you know, this column isn’t intended as psychotherapy or professional advice. It’s information and entertainment, and, I hope, the spark for some conversation with someone who can help with a problem. The problem here is anxiety in all its forms.

According to the Anxiety and Depression Association of America, about 31.9% of youth have some sort of anxiety disorder.  This would include diagnoses such as generalized anxiety, separation anxiety, panic disorder, and trauma disorders. It’s hard to believe this is accurate; if it is, then as a culture, things have gone horribly wrong. 

We know a lot about what works, and what doesn’t work for anxiety.  Isolation, the vortex of doom the internet can be, the misguided or malevolent support of random strangers online, endless social networking, and a sedentary, sleep-starved, junk-fed existence don’t work.  Overscheduling doesn’t work. Avoidance doesn’t work. Irresponsibility doesn’t work. So do the opposite.

Get off the devices except for schoolwork.

Get enough sleep. Go to bed at a set time, get up at a set time. Every day, even weekends.

Cut down on activities.

Read real books. Learn about other people’s interior lives via good fiction (that’s a primary reason that we read classic literature in school; to understand more about how other people think, feel, and respond to life’s events). Then talk about them. That means parents should read them, too.

Get physical activity.  A healthy young person needs at least two hours of activity a day, and ought to be standing, moving around, and active a big chunk of the rest of the time.  

Learn useful skills.  For example, everything it will take to manage one’s own money, car and home.

Socialize in person, often while doing something purposeful (whether that’s a sport, volunteering, or other activity).

Spend a lot of time in nature. If it can’t happen just about every day, plan a four- or five-hour chunk on the weekend.

Have chores and responsibilities for young people.  No, “school is not their job” and therefore nothing else is to be done around the house. How are they going to learn necessary life skills? Plus, who wants a spouse or roommate who thinks going to work covers them for any contribution to home and family life?

Learn mindfulness meditation skills, to slow down the stress response and “step back” from anxiety-provoking thoughts. This facilitates the cognitive restructuring of cognitive-behavioral therapy, in which new ways of thinking and behaving are identified and rehearsed.

…and try cognitive behavioral therapy (CBT), preferably with at least one parent learning, too, to be coach and to help the parent. Anxious parents tend to teach their children fear-fueled ways of thinking and behaving, and anxious parents are apt to facilitate avoidance.  Avoidance is like jet fuel for anxiety. Find a licensed mental health professional who will work with you as a family to teach the skills. Keep in mind that CBT will work much better if the other parts of life are in healthy, working order – proper sleep, nutrition, exercise, etc.

To expand on an earlier point: parents, often your anxiety feeds your child’s anxiety. If you are behaving as if the world is a terrible, dangerous place, do not be surprised if your child responds the same way.  Making changes together to have a healthier, less anxious lifestyle will help the whole family.