Category Archives: skills

start with the dishes.

This has already changed my life. I can tell.

 

6 Insanely Popular Ways to Waste a Life

 

 

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a new way to handle infant loss

So dang important. As a hospital social worker I faced this horrible situation way too often – the middle of the night, a groggy chaplain, teams of residents and nurses silently sobbing, the cries of a mother’s grief that don’t even sound human.

There’s no way to ease the pain they’re feeling, the ongoing grief they’ll feel…the going home to a finished nursery or the telling of friends or the baby gifts they won’t get to use. For some reason one of the most vivid images I have is of sitting in the room holding a mom and looking over to the table where this expensive camera sat, waiting to take pictures of a newborn…a toddler…the first day of kindergarten….it was awful.

We try to give the family as much time as they need with their child, with their little family that won’t ever leave this hospital. But this article is right: 2-4 hours often isn’t enough. In fact, the first couple of hours the mother may even refuse to see the child, saying she can’t do it. But most of the time she changes her mind, and we try to anticipate it – keeping the baby in another room until mom is ready. We take footprints even when mom says she doesn’t want to see them, create a memory box just in case. Sometimes family takes it and we hear later that mom/dad were so grateful later on when they had these keepsakes. I love this idea of slowing down, of letting the family have extra time to make decisions. We try to never tell the family there is a time limit, and honestly my families rarely use the whole time we’ve given them….but I think if the staff knew we had extra time we could aid in this slowing down process rather than feel the pressure of the clock and worry that we’d have to tell the family it’s time to physically let the child go.

I love these little suggestions, the colorful blanket or the recording family members. But this….this has changed the way I will handle infant loss forever:

It’s all about taking the time to say hello to their child before saying goodbye.

What a profound and incredible statement. Thank you, Megan, for the work you do and for taking time to share it with us.

Mandy Maneval faced infertility for years. Finally, three years ago, she became pregnant with twins. At a routine ultra sound, she was faced with the news that Aaron was lost at 20 weeks. Her little girl, Abigail (Abby), was healthy.

At 30 weeks, Mandy went into labor. She called her sister, Megan Shellenberger, a nurse at Penn State Milton S. Hershey Medical Center, located in Hershey, Pennsylvania. Megan spends most of her time working in labor and delivery, and she was quick to reassure Mandy that everything would be O.K.

Suspecting that baby Abigail had a heart defect, Mandy came to Penn State Milton S. Hershey Medical Center, the home of a leading neonatal cardiologist. The physicians were able to stop Mandy’s labor, but she would remain an inpatient until delivering Abby at 35 weeks.

Abby was born with two very complex heart defects. So rare, that her doctors described it…

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gross.

My coworker just taught me a Buddhist practice to combat what they call “attachment.” I’ve mentioned the concept of attachment before – that we mistake it often for love but it is really a poison in disguise. Attachment to anything – a person, belonging, idea, etc – overtakes our minds and often we obsess over the object of our attachment. For someone like me with clinically obsessive thoughts and a probably-clinical hatred of bodily functions….well, we’ll see how this goes.

ATTACHMENT
Definition: Exaggerated not wanting to be separated from someone or something. (Exact opposite of Aversion) Because the label of “pleasant” is very relative and based upon limited information, Attachment includes an aspect of exaggeration or “projection”.

Near “enemy” (or not to be confused with): Real appreciation, love and compassion.
Opposite: Wanting to be separated from someone or something: aversion.
Main quality: exaggeration of positive qualities, which can only lead to disappointment. Falling in love will usually fit very well in this category. (from View on Buddhism)

The practice my coworker was telling me about, in regards to attachment toward a person, consists of contemplation: sit and mediate on that thing that has such hold over your thoughts. Now think of all of the disgusting, feral aspects of that person. Imagine them without skin. See all of the sinews and blood and guts that make up their body. Think of mucus, of odor, of bowel movements and eye sockets.

I’m not kidding. This is a real practice (it came up because a patient down the hall has a disgusting hacking cough right now) and honestly, I guess I can see how it works. I’d like to know how permanent the images these meditation conjure would be….I don’t want to think of bodily fluids every time his name pops up on my phone. But then again, maybe I do, right?

Break the cycle. New associations. Turn my brain off of that thought and start the process of replacing it….I guess I can replace it with something else altogether once the initial obsession has broken. Maybe…emptiness? I don’t really have this Buddhism thing down…

HANDLING ATTACHMENT

One man can conquer a thousand times thousand men in battle,
but one who conquers himself is the greatest of conquerors.

The Dhammapada

The following antidotes can be applied throughout daily life, but are profound meditation exercises as well.

ANTIDOTE 1 – Observe Yourself: Do I exaggerate positive qualities of things I am attached to, are they really worth all my troubles? Is it really worth to work hard for days, weeks or months to have an hour of fun?

ANTIDOTE 2 – Use Your Inner Wisdom: Discover how exaggerated attachment is and how desire works against oneself. Try to be wiser than the monkey and let go of the candy to be free.

ANTIDOTE 3 – Reflect on the Unsatisfactory Nature of Existence. This is also called the First Noble Truth. How much fun is fun really, and how much is it forgetting the pain? Do desires ever stop or is it an endless job to fulfil them?

ANTIDOTE 4 – Reflect on Impermanence. How important is the person or object: everything will end someday, people die, things break.

ANTIDOTE 5 – Reflect on the Problems of Attachment. Lying in the sun is great, but it quickly leads to sunburn. Eating nice food is great, but it leads to indigestion and obesity. Driving around in big cars is great, but how long do I have to work to enjoy this?

ANTIDOTE 6 – Reflect on bodily attraction (lust for sex). Loving someone is great, but what happens when the “honeymoon-days” are over? But what is the body really? What more is it than a skin bag filled with bones, flesh, disgusting organs and fluids?

ANTIDOTE 7 – Reflect on the Results of Attachment. Greed and craving lead to stealing and all kinds of crime, including war. Addiction to alcohol and drugs are simply forms of strong craving; they destroy the addict and the surroundings. Uncontrolled lust leads to sexual abuse. The feeling of greed, craving and lust in themselves can be easily seen as forms of suffering.

ANTIDOTE 8 – Reflect on Death. What are all objects of attachment worth at “the moment of truth” or death?

ANTIDOTE 9 – Emptiness. The ultimate antidote to attachment and all other negative emotions is the realisation of emptiness.

Hmm.

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Aha! Moments

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

Okay, heads up: this entire post is a re-blog from PESIinc., a company that provides continuing education for a variety of professions. I kind of love them, even when they spam me four thousand times a day with courses I might like to take.

10 Ways to Help Stuck Clients Move Forward

posted Nov 24, 2015.

“I know it’s irrational, but I can’t stop the extreme anxiety I feel around people because I’m a 6’3” tall woman and fear they’ll think I’m a freak,” said Natalie, a 35-year old nurse. Though she was comfortable working with patients, was happily married, and had two very close friends, she couldn’t shake the anxiety she felt around colleagues and large groups of people.

“My last therapist taught me relaxation exercises, how to talk back to my negative thoughts, and encouraged me to get out socially with small groups,” Natalie added. “But none of that seems to work. The anxiety just hijacks my brain.”

She’s right. Sometimes, no matter how we try to outsmart it, our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think.

Orchestrating such felt experiences with your clients is easier than you think. In this post, I’ll share 10 strategies from my book, “The Therapeutic ‘Aha!’” that you can use to engage the emotional brain and help stuck clients move forward.

Strategy #1: Align, Lift, and Lead

Most of us were taught to validate our client’s feelings. However, if you spend too long merely validating your client’s pain, it can amplify negative feelings in the emotional brain. To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”

You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:

 “Natalie, I understand that you’ve had these experiences where you’ve not felt comfortable around large groups of people because you’ve not been sure how they would react to your height. Being a nurse, you’re obviously an empathic person and are probably pretty good at helping people feel at ease. I’m seeing you using these people skills in other social situations, too, realizing that a person’s reaction just tells you something about them, and you can sense how to put them at ease.”

Reframing her problem in this way helped Natalie feel more socially competent and encouraged.

Strategy #2: Visualize the Desired Response

Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.

Strategy #3: Identify Inspiring Goals

Instead of setting dry, lifeless goals like, “Client will practice relaxation skills and talk to two new people per week,” explore potential goals that have real value and meaning for your client.

When I explored inspiring goals with Natalie, she began talking about her desire to have lunch with a group of colleagues. They’d been inviting her to lunch for several weeks, and she liked the idea of connecting with fellow nurses. Targeting a small group of people she wanted to be around felt more intriguing and doable to her and less like a task.

Strategy #4: Locate the Root of an Emotional Conflict

Even though Natalie felt encouraged by this goal, she still felt a knot in her stomach at the thought of going out to lunch with these colleagues. I asked Natalie to follow the sensations in her stomach back to the first time she could remember having a similar feeling. Her eyes widened as she recalled being teased during lunchtime in middle school by a group of kids who called her names like “Amazon” and “Sasquatch.”

She had coped by avoiding the school cafeteria and doing her homework in the library during lunch. As a result, she avoided her bullying classmates and was praised by her teachers for being studious. Natalie gasped as she realized she was doing the same thing at her job­—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.

Once Natalie made this connection, she understood her emotional brain had simply continued the pattern because it had been adaptive for her in the past.

Strategy #5: Reverse Traumatic Memories

Natalie was excited to have made this connection, but just having cognitive insight into the cause of her social anxiety didn’t change it. In fact, recent neuroscience discoveries have shown us that in order for the emotional brain to change a response that was once adaptive, we have to recall the old memory while eliciting a new experience that invalidates the beliefs that got attached to the disturbing memory.

Strategy #6: Change Beliefs With Imagery and Metaphor

To change Natalie’s negative self-concept, we revisited her imagery of the redwood tree­—tall, beautiful, and majestic. I suggested she imagine the smaller trees laughing at the redwoods for being so tall and see the absurdity of it. Imagining this scene made Natalie laugh and realize every tree had its natural place in the world, and so did she.

Strategy # 7: Conjure Up Compelling Stories

Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.

The first time Natalie told her story about being bullied at school, she ended the story with an incident where a boy asked her to dance, then brought out a chair to the dance floor and stood on it so he could be as tall as she was. Everyone laughed, which made Natalie cry.

When I prompted her to consider a new ending to this story, she said, “Well I’ve been happily married for 15 years, and my husband said he was attracted to me because I was tall. He thought I looked like a graceful dancer.” She smiled and realized that ending her story this way suddenly caused the experiences she had with the boys in her youth to seem trivial.

Strategy #8: Prime With Play and Humor

Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,

“Who invited you to lunch with us, Amazon lady?”

I answered by simply saying, “Linda invited me.”

“Well I hope you don’t think I can be seen walking next to you, Sasquatch,” Natalie continued. And you should really consider doing something different with your hair.”

I smiled and replied, “Oh, what a shame. I fixed my hair this way just for you.”

Natalie laughed and we continued the role-play for a few more minutes. Letting Natalie play the character she feared reduced her anxiety because she realized how insecure a person would have to be to make such insensitive comments.

Strategy #9: Rouse With Rhythm and Music

Music can influence mood and neurochemistry, and it can entrain the brain to calmer states. One activity many clients enjoy is creating a playlist of tunes that evoke desired responses. Natalie started her playlist with “Creep” by Radiohead, which reflected her fears of being a social reject. Then we added “Everyday People,” by Sly and the Family Stone, which was more upbeat and affirmed that humans come in different colors, shapes, and sizes. Natalie ended her playlist with “Can’t Keep a Good Woman Down,” by Mary J. Blige, which helped her feel empowered.

Strategy #10: Integrate Mindful Movement

Movement can also engender desired states of mind. Dancing to her playlist helped Natalie shake off anticipatory anxiety, but I also suggested she could place her hand on her abdomen to calm her stomach and invoke a sense of self-compassion. She practiced this gesture while she slowed her breathing and imagined the beautiful redwood trees. Over the next several weeks, Natalie reported that her anxiety completely dissipated and she was able to comfortably enjoy lunch with her co-workers and other social situations.

Closing Thoughts

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

I hope this post has given you ideas for new techniques you can use, and that it leads to many “Aha!” moments for you and your clients.

Courtney Armstrong, LPC, MHSP, is a licensed professional counselor in Chattanooga, Tenn., and the author of “The Therapeutic ‘Aha!’: 10 Strategies for Getting Your Clients Unstuck.” She also offers training and free resources for therapists at her website: www.courtneyarmstrong.net.

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how do you feel today?

“Bipolar is not just a disorder of mood, it’s a disorder of judgment.”

image

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forgive.

“The Unity pastor suggested that we take a big yellow legal pad, and fill the front and back of a page, every day, for a week, writing “I deeply and completely forgive -________.” I don’t have a yellow legal pad but I do have a lined journal that will work just as well. I am going to take this challenge, because you know what? I want love in my life. I want healing. I want to stop drinking the poison.”

 

Original post from bipolaronfire.

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Back to Borderline.

“The urge was addictive, and I couldn’t think of anything else but ending my life. The ability to see how my death would hurt others was lost to me, and I still don’t quite know why I went back home after two hours. I stopped being angry, I think.

I have never considered suicide when depressed; even thinking about it would be too much effort in that situation. However, anger and panic are what drive me to think such thoughts, to harm myself, to chain-smoke and take more pills than I should. Any type of fear sends me into a blind panic; I just don’t know how to deal with the emotions. Or any emotion, really.”

From Halfway Between the Gutter.

While my therapist/psychiatrist and I established that I do not, clinically, have Borderline Personality Disorder (a constant nagging fear of which haunts me with surprising regularity), I definitely DO exhibit some serious BPD traits.  The above quote from HBG was like a lightbulb for me: it’s not depression that makes me think life is worthless, it’s anger and fear!  I’ve discussed my inability to name my emotions before, and with this new insight I feel like I have one more glimpse into the dysregulated organ that is my brain. Now to determine if I’m actually angry in these situations, or if it’s all a manifestation of fear. Specifically, the fear of being betrayed. Well, of being betrayed and not knowing about it. But still.

New goal: let’s separate the three emotions and figure out a better way to respond.  Like, now.  Actually like, two weeks ago would be nice. But you can’t undo the past, right? Dang it. #dbt.

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yes yes yes.

“Do you ever struggle to ID your emotions?

I don’t want CBT strategies right now, I just want someone to tell me what mood I’m in from time to time.”

From the Blahpolar Diaries.

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Hypomania

So strugglingwithbipolar linked to an article about hypomania, which led me to this next article about handling hypomania without obliterating it with medication.  First of all, I really don’t like that this guy calls people with the illness “bipolars.”  It’s actually really dated to refer to anyone as their disorder, and the current shift to the recovery paradigm in mental health teaches us to respect ourselves way more than that.  Regardless, the post is interesting.  I was recently medicated for being in a hypomanic state, and I had only been that way for about a week.  I told my doctor I felt “crazy” and that I couldn’t control my emotions, but I’m not sure I was truly on the track to mania.  Was it better to be safe than sorry? Will I permanently be on a higher dose of medication without actually seeing if I could have de-escalated on my own?  I guess I’d rather be here than in a hospital, but I have a great deal of clinical support in place – the hypomanic part of me really wants to see where it would have gone this time.

Which is why I blog.  To see just how textbook I am. ;) I told you I miss the mania.

Okay, whew, distracted.  Here is the article about hypomania. What do you think?  Can “Four Secrets” teach us to reign in hypomania and use it to our advantage? Is it worth a try?

PS: I think reducing it to four steps is like calling us “bipolars.” 

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naming the emotion

I just posted a comment on Jaen Wirefly’s blog and I thought maybe I’d post it here to remind myself and share the skill with others that may not know it.  Jaen is a smart cookie so I’m not saying anything she doesn’t already know, but I know from experience that being a social worker means we learn an incredible amount of skills and it’s impossible to remember them all the time.  Espesh when we live with emotional dysregulation ourselves.  Anyway, here’s my comment:

“One of the things we can learn to do is name our emotions – we tend to only think of things as “ANGRY” or “devastated :( ” or “SO HAPPY :D ” so we think we have a smaller range of emotions. But learning to define our emotions with other names and to distinguish between them, to learn that while we are experiencing SO ANGRY we can also experience other emotions, helps us to let them go and/or respond to them more appropriately. Just a thought!

http://www.listofhumanemotions.com/listofhumanemotions

A brilliant professor of mine said we can learn to see our emotions as if on a ticker tape (does anyone even know what that is anymore, ha) – we can view it separate from our bodies, watch it go by, watch it leave…which then gives us room to see what comes next on that ticker tape.  To experience the next emotion…to let go of the one that makes us feel so out of control.

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