Finding the right therapist is often likened to the dating process: It can be daunting, requires serious effort and is very fulfilling once you find the one.
And — just like in dating — knowing if, when and how to end or put that relationship on hold can be equally stressful. It’s nerve-wracking, confusing and can leave you wondering if you’re making the right decision.
The good news is: Therapists are trained to want you to stop.
“I think people get nervous their therapists are going to feel hurt that they’re leaving,” Lori Gottlieb, a psychotherapist and author of “Maybe You Should Talk To Someone,” explained to HuffPost. “Ours is the worst possible business model, because from day one our goal is how we can get you to be independent of us. We want you to be able to function without us.”
“Ours is the worst possible business model, because from day one our goal is how we can get you to be independent of us. We want you to be able to function without us.”
Growing out of your therapist can look many different ways, but there are concrete signs, and some of them exist outside the room, according to Meg Gitlin, psychotherapist and creator of the Instagram account City Therapist.
“I think it’s when the person starts internalizing your voice or is able to readily access the tools you have given them, when they come in and they say ‘oh, I was at my sister-in-law’s and I got into a tizzy about X,Y and Z but I was able to talk myself down and self-soothe,’” she said. “The things you practice and learn in therapy have no value unless you can take them outside of the room.”
Repeatedly struggling to come up with things to talk about in a session could also be a sign you’re ready to take a break, but Josephson warns against jumping the gun on that one.
“If you’re having a good week, it’s not a reason to cancel your therapy session,” she said. “Therapy is not a quick fix … But if you find yourself constantly coming up short of issues you really want to discuss I think it might be time to consider taking a pause.”
Taking a break or stopping altogether can feel scary, especially if you’ve been working with someone for a long time, but it can also be an opportunity to reflect on that work and see how it manifests in your daily life.
“There are many benefits of stopping or taking a break,” said Mark Aoyogi, director of sport and performance psychology at the University of Denver. “Reconnecting with your independence, practicing the skills you have developed, engaging in life with your deeper sense of self-awareness. It’s also a great opportunity for continued self-introspection on what has been learned, how to apply it and what works best” for you.
“If you are having apprehension about raising the topic of stopping with your therapist, that is probably an indication your therapist is not a good fit.”
As with anything, there are right and wrong ways to go about broaching the topic. The main one is: Don’t ghost someone who has committed time, care and effort into helping you. As Gottlieb puts it, it’s “a conversation.”
“We’re not going to keep you somewhere you don’t want to be,” she said. “At the same time, we’ll talk to you about where you think you’re at and what progress you’ve made and how you’re feeling. You can always leave and if something comes up you can come back ― our door is open. I think people need to feel really comfortable talking to their therapists about what they’re doing there and how long they’re going to be there.”
Importantly, Aoyogi said that if you’re seeing the right person, they will be supportive and understanding of your wishes.
“If you are having apprehension about raising the topic of stopping with your therapist, that is probably an indication your therapist is not a good fit,” he said. “I’m not sure therapy can be effective if you are feeling pressured to continue.”
Building Emotional Intelligence Isn’t as Hard as You Think
Source: Pixabay
Dozens of times a week, we ask friends, family, and even strangers, “How are you?” Given this fact alone, you’d think our society was very interested in how people feel.
But all of us know that this question generally doesn’t get an honest answer. Instead, most people reply with, “good,” “fine,” or at least, “okay.” If we’re really honest with ourselves, most of us would be a bit uncomfortable if we got a more genuine answer.
For many of us, it can feel risky to get in touch with our feelings, let alone to express them to others. I was recently speaking with a close friend who was genuinely hurt by something his father posted in a family chat room. He had been ruminating about it for days. And yet, when I suggested that he bring it up with his dad, his answer was straightforward: “No,” he told me. “We don’t talk about feelings in our family.”
Psychologist Marc Brackett, the founder of the Yale Center for Emotional Intelligence, argues that this tendency to avoid feelings, though understandable, can be a real disadvantage.
In one experiment, Brackett and his colleagues divided middle-school teachers into two groups. One group was placed in a good mood by recalling positive classroom experiences, while the other group was placed in a bad mood by recalling negative classroom experiences.
Then, they all were asked to grade the same essay. The teachers who were in a worse mood scored the essay a full letter grade lower than those in a better mood. But here’s the real kicker: Most of the teachers said they thought their mood had no influence on their grading, even though it clearly had.
Whether we like it or not, our feelings affect our thinking and behavior. Being out of touch with these feelings just means we’re at the mercy of them. So, it behooves us to get to know them better.
Our ability to understand and regulate our feelings is what psychologists often call “emotional intelligence.” Luckily, emotional intelligence isn’t a fixed commodity, but rather something we can build by learning what Brackett calls “emotion skills.”
He has developed a system, organized around the acronym R.U.L.E.R., which has been used in nearly 2,000 schools across the world to teach such skills to children and teenagers. But it can be equally applicable for helping all of us develop greater wisdom about our feelings and use them to our advantage.
Here are the five skills you can start practicing now:
R: Recognize
The first step toward productively managing any feeling is to recognize that we’re having it. Although this may sound easy, it’s equally easy to ignore our feelings. Have you ever said, “I don’t care,” about a situation when you really did? Have you ever gotten a head or neck ache, only to later realize you were actually feeling emotionally stressed?
To better recognize our feelings, Bracket suggests using a technique known as the “Mood Meter.” At its heart, this technique involves asking yourself two simple questions:
How much energy does this emotion have?
How pleasant is this emotion?
Emotions can be high in both, low in both, high in energy and low in pleasantness, or low in energy and high in pleasantness. Emotions high in both energy and pleasantness include joy, excitement, and optimism, while emotions low in both include sadness and depression. Anxiety, anger, and frustration are examples of feelings high in energy but low in pleasantness, whereas calmness and contentedness are examples of feelings low in energy but high in pleasantness. By at least identifying in which of these categories our feelings fall, we lay a foundation for wisely dealing with them.
U: Understand
The next emotion skill involves understanding our feelings. In short, this involves asking the question, “Why am I feeling this way?” Because this wide-open question is notoriously difficult to answer, in his book Permission to Feel, Brackett suggests some more specific questions we can ask ourselves to figure out the reasons behind our feelings. Here are a few of them:
What just happened? What was I doing before this happened?
What happened this morning, or last night, that might be involved in this?
What has happened before with this person that might be connected?
What memories do I have about the situation or place in which this emotion occurred?
Understanding the causes of our feelings can help provide clues about how to address them. If I’m feeling anxious because my new boss reminds me of a person from my past who was cruel to me, I’ll want to deal with the situation very differently than if my anxiety results from a particular managerial decision my boss just made. Of course, it could be both—so it can take serious time and introspection to really sort out what we’re experiencing and why. Be patient and keep at it.
L: Label
It’s not enough simply to recognize and understand an emotion; we also can benefit from finding the right word to describe it.
Many of us have a relatively limited emotion vocabulary. Some of us stick with two words: bad and good. Others might have three or four: happy, sad, mad, and scared. Still others may not use emotion words at all, but prefer figures of speech like, “on top of the world” or “burning up.”
But in actuality, there are thousands of words to describe emotions in the English language alone. We certainly don’t have to memorize all of them, but Brackett suggests that more accurate labels are usually better for us. In his words, “We know from neuroscience and brain imaging research that there is real, tangible truth to the proposition that ‘if you can name it, you can tame it.’”
For a start, knowing precisely what feelings we’re experiencing can give us clues about how to manage them. Although you may recognize that you’re experiencing a negative, high-energy emotion, both “stressed” and “overwhelmed” might fit that general description. But which of these labels most accurately describes our feeling really matters, because they mean different things.
“Stress” generally means we feel that what we’re trying to do or handle exceeds our capabilities, whereas “overwhelmed” means there’s just too much of it, regardless of our capabilities. If we’re feeling overwhelmed, the best approach may be to reduce our workload the best we can, whereas if we’re feeling stressed, the best approach may be to upgrade our capabilities by learning new skills or reorganizing the way we do things.
E: Express
If the R, U, and L of R.U.L.E.R. are about getting into touch with our emotions, the E and R are about what to do with them.
There are lots of reasons we hesitate to express our feelings. Especially when emotions fall on the negative end of the spectrum, we may be afraid they’re inappropriate, will embarrass us, or will somehow injure the person we express them to.
According to Brackett, however, “Hurt feelings don’t vanish on their own. They don’t heal themselves. If we don’t express our emotions, they pile up like a debt that will eventually come due.” So it’s important to express them in some way.
But this doesn’t mean we should let our emotions run wild, saying everything that’s on our minds to everyone we wish. According to Brackett, the skill of expressing our feelings “means knowing how and when to display our emotions, depending on the setting, the people we’re with, and the larger context.”
If we’re feeling hurt by something our boss said, for instance, it’s in our best interest to express this differently than if a close friend said something similar to us. Depending on the level of trust, we may make ourselves more vulnerable to our friend than our boss, expressing our feelings in greater depth or detail. If there’s a good chance we could lose our job, we may even choose not to express our hurt at all to our boss, instead confiding in and seeking support from someone else.
R: Regulate
The final emotion skill involves determining how to cope with our feelings.
Whether or not we choose to express them, feelings impact us. Regulating our emotions involves dealing with them in a way that allows us to best meet our personal and professional goals—or at least prevent our feelings from interfering with them. This certainly doesn’t mean ignoring our emotions; as already discussed, this doesn’t work well. Instead, it involves learning to accept and deal with them wisely.
Techniques for helping us cope with our feelings run the gamut, and we should strive to use ones that work for us. Relaxation videos abound on YouTube and can help us soothe strong emotions. Meditation phone apps can be used to facilitate mindfulness, which may help us accept our feelings. Physical exercise can help us to “work out” our feelings and feel more grounded in our bodies.
But emotion regulation can also be very simple. “You can’t stand your neighbor? Avoid her,” writes Brackett. “Your parents are coming to visit and you don’t want them to see some of your more outré artwork? Hide it until they leave. You’re tired? Splash some water on your face.” The important thing is to acknowledge our feelings—not avoid them—and then take productive steps toward dealing with them.
Learning to be more emotionally skilled isn’t a panacea. It won’t eliminate all our negative feelings or bring about a constant state of bliss. Such goals are probably impossible. But part of emotional intelligence is realizing that our feelings aren’t our enemies. In fact, if we approach them wisely, they can be some of our best friends. Let’s all get to know these friends a little better.
About the Author
David B. Feldman, Ph.D., is a professor in the department of counseling psychology at Santa Clara University.
Trained curiosity and assessment are not the soul of psychological change.
Posted Oct 13, 2019
Source: StartupStockPhotos/Pixabay
There is a vast gulf between diagnosable issues as seen through the lens of psychological expertise and the essence, identity, strengths, and hopes of a person before me. Psychotherapists mean well, but at times we all stray outside of the bounds of helpfulness. Here are seven ways psychotherapists get in the way of psychotherapy:
1. Interrogating
When people come into session in the midst of an emotional storm, the last thing they need is to be inundated with endless questions on the basis of an agenda that is likely intended more to fulfill organizational protocols than to promote a foundation of therapeutic empathy and rapport.
Questioning always runs the risk of interrogation. The details learned about people’s lives ever tempt helping professionals toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.
2. Pathologizing
The concept of “mental disorder” is rigid and misleading. In short, diagnosis is description, and by and large, mental health diagnosis provides description of “software” issues rather than “hardware,” so to speak. It’s a language of understanding what type of struggle a person is experiencing. When therapists refer to people by these diagnostic labels, we may overgeneralize a person’s experience and distance ourselves from a critical resource: the powerful, complex, and fluid process of therapeutic understanding, the power center of effective therapy.
3. Shaming
We ever risk a false sense of expertise about people’s lives against the backdrop of anxiety about our own. If we’re not careful, we may find ourselves reinforcing the tyranny of the perceived should. Should is shame‘s accomplice, and therapists must take care not to aid and abet them.
4. Sympathizing
Researcher Brené Brown (2010) rightfully proclaimed, “Empathy fuels connection, while sympathy drives disconnection.” Saying you understand is unhelpful and probably not true. And let’s be honest: It’s usually a ploy to rush people out of their emotional state, which sends the message, “I really don’t care enough to walk with you through your suffering.”
Source: Gerd Altmann/Pixabay
5. Lecturing
Psychologist and psychotherapy researcher Les Greenberg (2002) wrote, “Darwin, on jumping back from the strike of a glassed-in snake, having approached it with determination not to start back, noted that his will and reason were powerless against even the imagination of a danger that he had never even experienced. Reason is seldom sufficient to change automatic emergency-based emotional responses.”
With a surge in cognitive therapies, there has been a surge in their wrongful implementation, with many therapists engaging in power struggles to convince people of faulty beliefs in order for new, more positive truths to simply work some magic ripple effect into their lives.
As an emotion-focused therapist, I have been prone to, for instance, encourage couples to engage in safer, softer, and more emotionally responsive interactions, yet when I have stood on my own soapbox, encouraging them to do so out of pace with their own readiness, I have violated my own guidance. Miller (1986) observed that people will “persist in an action when they perceive that they have personally chosen to do so.”
6. Babbling
Silence can provoke anxiety, even for therapists, who think they should surely be redirecting, conjecturing, advising. I find myself observing people in therapy watch me watch them watching me watch them. And I have found a power in it. Like a Rorschach ink blot, presence has power in and of itself to nudge a person’s anxiety so it presents and speaks up for itself.
My former colleague, Blanche Douglas (2015), wrote: “There was a method in Freud‘s madness when he prescribed the analyst be as undefined as possible, not disclosing details about his life and sitting behind the patient out of sight, saying little. This forced the patient to make meaning out of an ambiguous situation, and the only way he could do this was by recourse to his own experiences.”
7. Methodologizing
If a psychotherapist is lifeless or their technique too technical, their efforts to help may be worthless. Therapy, in this case, is not a relationship but a poor excuse for scientific experimentation. The mechanisms of some psychotherapies undermine their therapeutic value. When we fixate on therapeutic modality, we run great risk of missing prime opportunities to interject the most valuable therapeutic tool we have to offer—ourselves.
Source: Cristofer Jeschke/Unsplash
Conclusion
As a new therapist, I remember trying hard to demonstrate my own capacity for psychological insight—even though, I must confess for my wise professors’ sake, I was certainly not trained to be an egotistical show-off. Fortunately, somewhere along the way, I started to better understand and experience the disparity between knowing and being. All these years, I am still learning each day how to lean into the latter. There is something powerful in it, not just in the experience of the therapist but in the experience of the therapy.
The family therapy pioneer Lynn Hoffman, who sadly died in 2017, gave a language of values for sitting with clients—the non-expert position, relational responsibility, generous listening, one perspective is never enough.
If a therapist is not fully present as a warm, accepting, genuine, caring, and appropriately vulnerable person, the power center of therapy remains turned off. Whatever insight may come along the way, meaningful, sustainable change requires transformative experiencing. Analysis without encounter is nihilistic, all the apparatus of thought busily working in a vacuum. Only in the context of authentic relationship and therapeutic alliance can I grasp and catalyze the breadth and depth of formidable resources already existing within my clients.
Chronic insomnia is defined as at least three restless nights per week for at least three months. (Alyssa L. Miller, Flickr cc)
While the American College of Physicians (ACP) can’t say cognitive behavioural therapy (CBT) outperforms medications for chronic insomnia, the group does say psychotherapy is less risky than drugs.
“Sometimes we forget that sleep medications have the potential for serious side-effects in some patients, while cognitive behavioural therapy is very low [risk] to patients,” said Dr. Wayne J. Riley, ACP president.
“The evidence is clear that CBT and sleep hygiene can be long lasting, life long, durable and delivered at a lower cost,” said Riley, who is also affiliated with Vanderbilt University in Nashville.
About 6 to 10 per cent of people in the U.S. have insomnia. Through loss of productivity, the condition is estimated to have cost the country about $63 billion US in 2009, according to the ACP committee that wrote the new guideline, which is published in the Annals of Internal Medicine.
Chronic insomnia is defined as at least three restless nights per week for at least three months.
“We wanted to take a deep dive into the literature for what makes a big difference with insomnia,” Riley told Reuters Health.
The ACP commissioned two reviews of insomnia treatments. One focused on medications, and the second focused on psychological and behavioural treatments.
Medication and ‘sleep driving’
Overall, the first review found that some medications may improve sleep over a short period of time, but those come with the potential for changes in thinking and behaviour. Additionally, there is a risk for infrequent but serious harms.
The U.S. Food and Drug Administration says medications for insomnia should only be used for short periods. The agency warns those drugs may impair people during the daytime, lead to “sleep driving,” behavioural changes and worsening depression.
The review of psychological and behavioural treatments found that CBT for insomnia improved overall sleep with a low risk of harms, the researchers report.
Evidence collected separately for the two reviews found that “side-effects can be quite severe with the use of insomnia medications in contrast to CBT, where there are minimal side-effects,” said Riley.
CBT for insomnia is typically delivered in four to six one-hour weekly sessions. People are taught behavioural techniques such as sleep restriction and stimulus control, and they are also taught sleep hygiene.
When chronic insomnia isn’t helped by CBT alone, the ACP advises patients and doctors to consider a short course of medication. That discussion should touch on the potential benefits, harms and costs of medication, the ACP says.
Doctors should encourage patients with insomnia to engage in CBT, according two researchers whose editorial was published with the reviews and the guideline.
‘Prescription not the best solution in the long term’
But, they admit, CBT for insomnia might not be covered by insurance and is likely not available at doctors’ offices, write Dr. Roger Kathol, of the University of Minnesota in Minneapolis, and J. Todd Arnedt, of the University of Michigan Medical School in Ann Arbor.
“Unless access to and unencumbered payment for value-based behavioural interventions, such as CBT (for insomnia), in medical settings become a reality, patients with chronic insomnia will continue to receive suboptimal treatment and experience suboptimal outcomes,” they write.
Alternatives to in-person CBT for insomnia include group therapy session, telephone counseling, online lessons and self-help books, Riley said.
The ACP recommendations are similar to that of the American Academy of Sleep Medicine (AASM), said Dr. Alcibiades Rodriguez, who is medical director of NYU Langone Medical Center’s Comprehensive Epilepsy Center-Sleep Center in New York City.
The AASM’s 2008 practice guidelines for treating chronic insomnia endorse psychotherapy as a first-line treatment and suggests it be used when medications are prescribed.
“The recommendations made by the ACP will appeal to a broader group of physicians to make them aware of this,” said Rodriguez, who was not involved with the new recommendations. “Then the doctors know just giving patients who come to their office with sleep problems a prescription is not the best solution in the long term.”
A poet and residential school survivor is releasing her latest collections of poems, and she says they have been instrumental in healing from the scars of residential schools.
Louise Bernice Halfe was was born in Two Hills, Alta., and completed programs at the University of Regina and University of Saskatchewan. She attended the Blue Quills Residential School, near St. Paul, Alta., for six years.
While the recently finished Truth and Reconciliation Commission was intended to help survivors heal, Bernice Halfe said the process opened old wounds. This collection of poetry, Burning in this Midnight Dream, helped heal those wounds.
Traditional ceremonies, psychology needed to help others
“It’s been extremely challenging and frightening as well,” she said of the process of walking backward, and retracing her past through the poetry. “What scared me was the feeling of being exposed and vlunerable.”
She said she needed to press ahead as a process of “accepting responsibility of my own actions and behaviours,” but the poetry is “also for the people who don’t have the vocabulary to articulate the shame and the pain and the anger that goes within their own stories.”
Bernice Halfe has training in drug and alcohol counseling, and in social work. She also emphasized the importance of psychotherapy and talking as tools for healing.
‘How do you recover as quickly as the people in the Canadian public want us to recover? I don’t know; I hope it’s possible. It’s very very hard.’– Louise Bernice Halfe
When asked how she wants to contribute to conversations on the legacy around residential schools, she described a photograph that showed her parents’ wedding and all of her relatives connected to her parents.
“There’s been a generational impact on whole communities. How do you recover as quickly as the people in the Canadian public want us to recover? I don’t know. I hope it’s possible. It’s very, very hard,” she said.
Bernice Halfe said she wants to see more aboriginal therapists and psychologists. “Not the kind that just prescribe pills,” she said.
Part of that responsibility is shared by the government, which she said has been insufficient in providing deep healing for aboriginal communities to recover from the legacy of residential schools.
“I would like to see more people trained in psychotherapy, along with their [traditional] ceremonial practices,” she said. “We needing funding for education in our communities. We also need mental health services closer to the communities.
“I’m talking about talk therapy. I’m talking about psychologists,” she emphasized.
Louise Bernice Halfe launches her latest collection of poems on Thursday at McNally Robinson in Saskatoon at 7 p.m. CST.
In terms of health care, we have it pretty good. If you are unfortunately diagnosed with cancer, most, if not all of your treatment will be paid for. If you break your leg, you can go to the ER and get a cast and leave without a bill. If you require surgery, the government will pay for that too. But what if your issue isn’t physical? What if what’s holding you back in life is a mental concern? Well, then you’re kind of out of luck.
There are indeed mental health services that are covered by provincial programs such as OHIP here in Ontario. We are all allowed free access to psychiatrists, which sounds great on the surface. But the real story is that most psychiatrists are incredibly overworked and many have waiting lists over a year long. For anyone who has ever experienced a mental health crisis, you know that waiting a year just isn’t an option.
And if you are mentally well enough to wait for that year (or more) there is only so much a psychiatrist can do for you with their limited time and vast client lists. Sure, they can prescribe and monitor your medication. But they typically don’t have time to sit down with you week after week and get to the real reasons why you are facing either depression, anxiety, addiction or any other mental health issue.
Psychotherapists specialize in that kind of ‘getting to the root of the problem’ type of therapy. And each year, countless lives are changed by the hundreds of excellent psychotherapists we have in this country. But for every life that is changed by psychotherapy, their lives are also changed by way of having to spend their hard-earned money and by prioritizing their mental health, sometimes at the expense of other important bills.
Whenever I am discussing treatment with a new client, their first question is inevitably ‘is this covered by the government?’
My answer has to unfortunately be ‘no, it’s not. But someday, I sure hope it will be.’
There are of course some private benefit packages that do cover psychotherapy but most of us are not lucky enough to have such in depth personal coverage from our employers. And that leaves many paying out of pocket for what can be a fairly costly expenditure.
If therapy was free for everyone in Canada, we would see an incredible reduction in the amount of sick days due to depression and anxiety. Productivity would go through the roof and our emergency rooms would be able to focus more of physical injuries instead of having to attend to mental health crises as well.
We are a progressive country and we lead in many areas. Unfortunately we are falling flat when it comes to mental health treatment. We’ve decided that only the rich and prosperous can have access to therapy.
And that just doesn’t sound very progressive to me.
With that expert’s list of ways to manage anxiety, the latest trendy mental health app and that “magical cure for depression” your aunt heard about on TV, it seems like everyone’s full of mental health advice these days.
With that expert’s list of ways to manage anxiety, the latest trendy mental health app and that “magical cure for depression” your aunt heard about on TV, it seems like everyone’s full of mental health advice these days.
So, we asked our mental health community to share pieces of advice they’ve actually found helpful. These little nuggets of wisdom aren’t FDA-approved, but when used correctly side effects may include: self-care, acceptance and a little more patience with yourself.
Here’s some advice that’s actually helped people with mental illness:
1. “On a particularly difficult day, I was trying to fight through an anxiety attack and finish all the child-related tasks I needed to complete. My husband kept offering help, and I kept refusing. He pulled me aside in the laundry room as I was frantically folding another load and said, “Just let me help you.” It doesn’t immediately make the anxiety go away, but it’s helped me learn to let go.” — Maria Heldreth
2. “Don’t wait. See a doctor. Don’t be afraid to ask for help. Don’t be embarrassed. Chances are, someone knows exactly what you’re going through.” — Kristin Salber
3. “I have depression and anxiety (as well as other chronic medical conditions), and after the worst week I’ve had in a while, my doctor said,“Find something you enjoy, and if you can’t find that, find the joy in something.” This really had an impact on me and still reminds me to look for a silver lining.” — Faith Merryn
4. “I have generalized anxiety disorder, and I made friends with someone who’s extremely similar to me. She told me to always be myself and the people who truly care will stick around. It truly did help.” — Julia Ann Lange
5.“Words can hurt to say, but they need to come out. Write all those words down on paper.” — Melissa Cote
6. “A friend recently told me that no matter if I get a job one day or not,your life matters as long as you can make people smile. When I think of it that way, it’s easier to see my life as something of worth.” — Emma Wozny
7. “A great therapist I had told me to focus on ‘harm-reduction, not perfection.’ I felt like I was expected to magically ‘get better,’ and she helped me learn that starting with baby steps was totally OK.” — Jen Decker
8. “Someone said, ‘I’ve been here, I know a way out, I’m here to show you too.’ And, ‘It gets better, it may not leave, but it gets better. And it has.” — Tom Everman
9. “I have anxiety and major depressive disorder. This is going to sound ridiculous, but my best friend once told me, “When you’re sad, watch ‘The Simpsons.’” It actually works when I’m panicking, too. It gets my mind off whatever I’m obsessing about, and I usually end up laughing.” — Dawn Czarnecki Seshadri
10. “It wasn’t long after my diagnosis that I was told pretty bluntly: ‘This illness is has no cure. You’re going to carry this illness for the rest of your life. So you can either wallow in the weight of that, or you can fight for your only life and make it a good story.’” — Lyss Trayers
11. “My depression and anxiety stem from a traumatic childhood. Just hearing ‘it wasn’t your fault‘ from my psychologist was incredibly helpful.” — Kathrine Elise
12. “Don’t always believe what your brain is telling you.” — Kerri Lewis Brock
13. “It’s OK to feel sad. You don’t need to pretend.” — Allyson White
14. “The best advice: Treat yourself as if you were a good friend.”— Julie Jeatran
15.“Celebrate every accomplishment, no matter how small,instead of dwelling on all the things we perceive as failures.” — Jennifer Northrup
16. “I have post-traumatic stress disorder and bipolar disorder. When I was in intensive outpatient therapy, the counselor looked at us and said,‘It’s over. That moment is over. It isn’t going to happen again.’For some reason, that resonated with me.” — Nicole Hanes
17. “They told me this: ‘You are not broken; you are a whole person. You are just human. A human who is living, learning and growing. And learning, living and growing comes with bumps in the road. Remember that this is just a bump.‘” — Kallie Kieffer
18.“Your worst days will only be 24 hours.“ — Arielle Smith
19.“You wouldn’t skip a dialysis or chemotherapy appointment. Your therapy appointments are just as important. No excuses.” — Jennifer Davis
20. “‘I think you need to give therapy a try.‘ Thanks to that, I started therapy and I’m now on the path to recovery.” — Julianne Leow
21.“Your struggles are your accomplishments in disguise.” — Katherine J Palmer
Part catalyst for change and part epic road movie, CLARA’S BIG RIDE is an inspiring new film that tackles the profound conversation about mental health and the stigma that surrounds it.
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Chronicles an unprecedented 11,000 km bicycle journey across Canada by Olympic medallist and Bell Let’s Talk spokesperson Clara Hughes.
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Joined by Dr. Marla Shapiro & Clara Hughes, Marilyn Denis uncovers the stories of 5 remarkable Canadians who struggle with mental illness.
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Richie from Montreal discusses overcoming anxiety and gets to meet and interview Clara Hughes for his university’s radio show.
By JANICE WOODAssociate News Editor Reviewed by John M. Grohol, Psy.D. on September 27, 2014
While antidepressants are the most commonly used treatment for social anxiety disorder, cognitive behavioral therapy (CBT) is more effective and — unlike medication — can have lasting effects long after treatment has stopped, according to a new study. CBT is one of the most common forms of talk therapy or psychotherapy.
According to researchers at John Hopkins University, social anxiety disorder, which is characterized by intense fear and avoidance of social situations, affects up to 13 percent of Americans and Europeans.
Most people never receive treatment. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists, according to the researchers.
“Social anxiety is more than just shyness,” said study leader Evan Mayo-Wilson, D.Phil., a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.
“People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction.
“The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering.”
The study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.
For the new study, the researchers analyzed data from 13,164 participants in 101 clinical trials. All had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo, while more than 4,000 received a psychological intervention.
Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone, the researchers noted.
After comparing several different types of talk therapy, the researchers found that individual CBT was the most effective. CBT, which focuses on relationships between thoughts, feelings and behaviors, helps people challenge irrational fears and overcome their avoidance of social situations, according to Mayo-Wilson.
For people who don’t want talk therapy, or who lack access to CBT, the most commonly used antidepressants — selective serotonin reuptake inhibitors (SSRIs) — are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn’t work at all for some people, and that improvements in symptoms do not last after patients stop taking the pills.
The researchers acknowledge that medication is important, but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy.
According to Mayo-Wilson, the analysis has already led to new treatment guidelines in the U.K. and it could have a “significant impact on policymaking and the organization of care in the U.S.”
“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce health care costs,” Mayo-Wilson said.
“The health care system does not treat mental health equitably, but meeting demand isn’t simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff,” he said.
This is a great resource to learn some communication skills.
Creative Commons copyright.
Enjoy,
Rory
Challenge One: Listening — Empathy in Action
Connect More Deeply by Listening More Attentively and Responsively
A chapter in The Seven Challenges Workbook A Guide to Cooperative Communication Skills for Success at Home and at Work
by Dennis Rivers, MA — 2012 Edition
SUMMARY (repeated from Introduction) Listen first and acknowledge what you hear, even if you don’t agree with it, before expressing your experience or point of view . In order to get more of your conversation partner’s attention in tense situations, pay attention first: listen and give a brief restatement of what you have heard (especially feelings) before you express your own needs or position. The kind of listening recommended here separates acknowledging from approving or agreeing . Acknowledging another person’s thoughts and feelings does not have to mean that youapprove of or agree with that person’s actions or way of experiencing, or that you will do whatever someone asks.
By listening and then repeating back in your own words the essence and feeling of what you have just heard, from the speaker’s point of view, you allow the speaker to feel the satisfaction of being understood, (a major human need). Listening responsively is always worthwhile as a way of letting people know that you care about them. Our conversation partners do not automatically know how well we have understood them, and they may not be very good at asking for confirmation. When a conversation is tense or difficult it is even more important to listen first and acknowledge what you hear . Otherwise, your chances of being heard by the other person may be very poor.
Listening to others helps others to listen. In learning to better coordinate our life activities with the life activities of others, we would do well to resist two very popular (but terrible) models of communication: arguing a case in court and debating. In courts and debates, each side tries to make its own points and listens to the other side only to tear down the other side’s points. Since the debaters and attorneys rarely have to reach agreement or get anything done together, it doesn’t seem to matter how much ill will their conversational style generates. But most of us are in a very different situation . We probably spend most of our lives trying to arrange agreement and cooperative action, so we need to be concerned about engaging people, not defeating them. In business (and in family life, too) the person we defeat today will probably be the person whose cooperation we need tomorrow!
As Marshall Rosenberg reported in his book, Nonviolent Communication , “studies in labor-management negotiations demonstrate that the time required to reach conflict resolution is cut in half when each negotiator agrees, before responding, to repeat what the previous speaker had said.” (my emphasis)
When people are upset about something and want to talk about it their capacity to listen is greatly diminished. Trying to get your point across to a person who is trying to express a strong feeling will usually cause the other person to try even harder to get that emotion recognized. On the other hand, once people feel that their messages and feelings have been heard, they start to relax and they have more attention available for listening. For example, in a hospital a nurse might say, after listening to a patient: “I hear that you are very uncomfortable right now, Susan, and you would really like to get out of that bed and move around. But your doctor says your bones won’t heal unless you stay put for another week.” The patient in this example is much more likely to listen to the nurse than if the nurse simply said: “I’m really sorry, Susan, but you have to stay in bed. Your doctor says your bones won’t heal unless you stay put for another week.” What is missing in this second version is any acknowledgment of the patient’s present experience.
The power of simple acknowledging. The practice of responsive listening described here separates acknowledging the thoughts and feelings that a person expresses from approving, agreeing, advising, or persuading. Acknowledging another person’s thoughts and feelings…
…still leaves you the option of agreeing or disagreeing with that person’s point of view, actions or way of experiencing.
…still leaves you with the option of saying yes or no to a request.
…still leaves you with the option of saying more about the matter being discussed.
One recurring problem in conflict situations is that many people don’tseparate acknowledging from agreeing. They are joined together in people’s minds, somewhat like a two-boxes-of-soap “package deal” in a supermarket. The effect of this is, let us say, that John feels that any acknowledgment of Fred’s experience implies agreement and approval, therefore John will not acknowledge any of Fred’s experience. Fred tries harder to be heard and John tries harder not to hear. Of course, this is a recipe for stalemate (if not disaster).
People want both: to be understood and acknowledged on the one hand, and to be approved and agreed with, on the other. With practice, you can learn to respond first with a simple acknowledgment. As you do this, you may find that, figuratively speaking, you can give your conversation partners half of what they want, even if you can’t give them all of what they want. In many conflict situations that will be a giant step forward. Your conversation partners will also be more likely to acknowledge your position and experience, even if they don’t sympathize with you. This mutual acknowledgment can create an emotional atmosphere in which it is easier to work toward agreement or more gracefully accommodate disagreements. Here are three examples of acknowledgments that do not imply agreement:
Counselor to a drug abuse client: “I hear that you are feeling terrible right now and that you really want some drugs. And I want you to know that I’m still concerned this stuff you’re taking is going to kill you.”
Mother to seven-year-old: “I know that you want some more cake and ice cream, Jimmy, because it tastes so good, but you’ve already had three pieces and I’m really worried that you’ll get an upset tummy. That’s why I don’t want you to have any more.”
Union representative to company owner’s representative: “I understand from your presentation that you see XYZ Company as short of cash, threatened by foreign competition, and not in a position to agree to any wage increases. Now I would like us to explore contract arrangements that would allow my union members to get a wage increase and XYZ Company to advance its organizational goals.”
In each case a person’s listening to and acknowledgment of his or her conversation partner’s experience or position increases the chance that the conversation partner will be willing to listen in turn. The examples given above are all a bit long and include a declaration of the listener’s position or decision. In many conversations you may simply want to reassure your conversation partner with a word or two that you have heard and understood whatever they are experiencing. For example, saying, “You sound really happy [or sad] about that,” etc.
As you listen to the important people in your life, give very brief summaries of the experiences they are talking about and name the want or feeling that appears to be at the heart of the experience. For example:
“So you were really happy about that…”
“So you drove all the way over there and they didn’t have the part they promised you on the phone. What a let-down…
“Sounds like you wanted a big change in that situation…”
“Wow. Your dog got run over. You must be feeling really terrible…”
The point here is to empathize, not to advise. If you added to that last statement, “That total SLOB!!! You should sue that person who ran over your dog. People need to pay for their mistakes, etc.”, you would be taking over the conversation and also leading the person away from her or his feelings and toward your own.
Other suggestions about listening more responsively:
As a general rule, do not just repeat another person’s exact words.Summarize their experience in your own words . But in cases where people actually scream or shout something, sometimes you may want to repeat a few of their exact words in a quiet tone of voice to let them know that you have heard it just as they said it.
If the emotion is unclear, make a tentative guess, as in “So it sounds like maybe you were a little unhappy about all that…” The speaker will usually correct your guess if it needs correcting.
Listening is an art and there are very few fixed rules. Pay attention to whether the person speaking accepts your summary by saying things such as “yeah!”, “you got it,” “that’s right,” and similar responses.
If you can identify with what the other person is experiencing, then in your tone of voice (as you summarize what another person is going through), express a little of the feeling that your conversation partner is expressing. (Emotionally flat summaries feel strange and distant.)
Such compassionate listening is a powerful resource for navigating through life, and it also makes significant demands on us as listeners. We may need to learn how to hold our own ground while we restate someone else’s position. That takes practice. We also have to be able to listen to people’s criticisms or complaints without becoming disoriented or totally losing our sense of self worth. That requires cultivating a deeper sense of self worth, which is no small project. In spite of these difficulties, the results of compassion-ate, responsive listening have been so rewarding in my life that I have found it to be worth all the effort required.
Real life examples. Here are two brief, true stories about listening. The first is about listening going well and the second is about the heavy price people sometimes pay for not listening in an empathic way.
John Gottman describes his discovery that listening really works: “I remember the day I first discovered how Emotion Coaching [the author’s approach to empathic listening] might work with my own daughter, Moriah. She was two at the time and we were on a cross-country flight home after visiting with relatives. Bored, tired, and cranky, Moriah asked me for Zebra, her favorite stuffed animal and comfort object. Unfortunately, we had absentmindedly packed the well-worn critter in a suitcase that was checked at the baggage counter.
“I’m sorry, honey, but we can’t get Zebra right now. He’s in the big suitcase in another part of the airplane,” I explained.”I want Zebra,” she whined pitifully.
“I know, sweetheart. But Zebra isn’t here. He’s in the baggage compartment under-neath the plane and Daddy can’t get him until we get off the plane. I’m sorry.”
“I want Zebra! I want Zebra!” she moaned again. Then she started to cry, twisting in her safety seat and reaching futilely toward a bag on the floor where she’d seen me go for snacks.
“I know you want Zebra,” I said, feeling my blood pressure rise. “But he’s not in that bag. He’s not here and I can’t do anything about it. Look, why don’t we read about Ernie,” I said, fumbling for one of her favorite picture books.
“Not Ernie!” she wailed, angry now. “I want Zebra. I want him NOW!”
By now, I was getting “do something” looks from the passengers, from the airline attendants, from my wife, seated across the aisle. I looked at Moriah’s face, red with anger, and imagined how frustrated she must feel. After all, wasn’t I the guy who could whip up a peanut butter sandwich on demand? Make huge purple dinosaurs appear with the flip of a TV switch? Why was I withholding her favorite toy from her? Didn’t I understand how much she wanted it?
I felt bad. Then it dawned on me: I couldn’t get Zebra, but I could offer her the next best thing — a father’s comfort. “You wish you had Zebra now,” I said to her. “Yeah,” she said sadly.
“And you’re angry because we can’t get him for you.”
“Yeah.”
“You wish you could have Zebra right now,” I repeated, as she stared at me, looking rather curious, almost surprised. “Yeah,” she muttered. “I want him now.”
“You’re tired now, and smelling Zebra and cuddling with him would feel real good. I wish we had Zebra here so you could hold him. Even better, I wish we could get out of these seats and find a big, soft bed full of all your animals and pillows where we could just lie down.” “Yeah,” she agreed.
“We can’t get Zebra because he’s in another part of the airplane,” I said. “That makes you feel frustrated.” “Yeah,” she said with a sigh.
“I’m so sorry,” I said, watching the tension leave her face. She rested her head against the back of her safety seat. She continued to complain softly a few more times, but she was growing calmer. Within a few minutes, she was asleep.
Although Moriah was just two years old, she clearly knew what she wanted — her Zebra. Once she began to realize that getting it wasn’t possible, she wasn’t interested in my excuses, my arguments, or my diversions. My validation, however, was another matter. Finding out that I understood how she felt seemed to make her feel better. For me, it was a memorable testament to the power of empathy.”
Sam Keen describes a friend’s lament about the consequences of not listening deeply: “Long ago and far away, I expected love to be light and easy and without failure.
“Before we moved in together, we negotiated a prenuptial agreement. Neither of us had been married before, and we were both involved in our separate careers. So our agreement not to have children suited us both. Until… on the night she announced that her period was late and she was probably pregnant, we both treated the matter as an embarrassing accident with which we would have to deal. Why us? Why now? Without much discussion, we assumed we would do the rational thing — get an abortion. As the time approached, she began to play with hypothetical alternatives, to ask in a plaintive voice with half misty eyes: `Maybe we should keep the baby. Maybe we could get a live-in helper, and it wouldn’t interrupt our lives too much. Maybe I could even quit my job and be a full-time mother for a few years.` ”
“Maybe . . .“ To each maybe I answered: “Be realistic. Neither of us is willing to make the sacrifices to raise a child.“ She allowed herself to be convinced, silenced the voice of her irrational hopes and dreams, and terminated the pregnancy.
“It has been many years now since our `decision,` and we are still together and busy with our careers and our relationship. Still no children, even though we have recently been trying to get pregnant. I can’t help noticing that she suffers from spells of regret and guilt, and a certain mood of sadness settles over her. At times I know she longs for her missing child and imagines what he or she would be doing now. I reassure her that we did the right thing. But when I see her lingering guilt and pain and her worry that she missed her one chance to become a mother, I feel that I failed an important test of love. Because my mind had been closed to anything that would interrupt my plans for the future, I had listened to her without deep empathy or compassion. I’m no longer sure we made the right decision. I am sure that in refusing to enter into her agony, to share the pain of her ambivalence, I betrayed her.”
“I have asked for and, I think, received forgiveness, but there remains a scar that was caused by my insensitivity and self-absorption.”
[ Workbook editor’s note: I have not included this real life excerpt to make a point for or against abortion. The lesson I draw from this story is thatwhatever decision this couple made, they would have been able to live with that decision better if the husband had listened in a way that acknowledged all his wife’s feelings rather than listening only to argue her out of her feelings. What lesson do you draw from this story? ]
First exercise for Challenge 1: Active Listening. Find a practice partner. Take turns telling events from your lives. As you listen to your practice partner, sum up your practice partner’s overall experience and feelings in brief responses during the telling:
Your notes on this exercise:
Second exercise for Challenge 1: Learning from the past with the tools of the present. Think of one or more conversations in your life that went badly. Imagine how the conversations might have gone better with more responsive listening. Write down your alternative version of the conversation.
Suggestions for reading on the topic of listening.
The Power of Listening – An Ancient Practice for Our Future: Leon Berg
Free Article: Tell Me More an essay by Brenda Ueland, explores the transformative power of listening to friends and familiy members:
“I want to write about the great and powerful thing that listening is. And how we forget it. And how we don’t listen to our children, or those we love. And least of all — which is so important too — to those we do not love. But we should. Because listening is a magnetic and strange thing, a creative force. Think how the friends that really listen to us are the ones we move toward, and we want to sit in their radius as though it did us good, like ultraviolet rays.”
Free Article: Positive Deviant is a magazine article about the transformative power of deep listening, as it occurred in a program to reduce child malnutrition in Vietnam. It is one of the clearest examples I have ever read of what is now called “appreciative inquiry,” which advocates that helpers pay disciplined and systematic attention to the strengths, capacities and past successes of those people they wish to help.
[from the editor] Forms of compassionate listening have been practiced among Quakers and Buddhists for centuries, and among psychotherapists for decades. The late Gene Knudsen Hoffman (1919 – 2010) was both a Quaker peace activist and a pastoral counselor, and in my view she achieved two great things over the course of her life. First, she took the practice of compassionate listening out of the quiet environs of the Quaker meeting house, out from behind the closed doors of therapy session, and on to the stage of the world’s greatest conflicts. Her many trips to Russia and the Middle East have made her a legend in the peacemaking community. Second, she popularized compassionate listening in a generous way that invites and encourages other people to take up this practice, develop it and apply it in new areas. This small book is an expression of that generosity. Available for free around the world as an e-book, it includes both her lesson plans for Compassionate Listening Workshops and reports from Leah Green and Cynthia Monroe, two of her co-pioneers and creative colleagues.
Books: The following books can be found around the world, new and used, via the links below provided by the Global Find-A-Book service of Human Development Books, the publsher of this Seven Challenges Workbook. Click on the book titles below to bring up a Global Find-A-Book page for each title.
Listening is an essential skill worth every effort to learn and to master. Listening takes us out of our tendency toward self-absorption and self-protection. It opens us to the world around us and to the persons who matter most to us. When we listen, we learn, we grow, and we are nourished.
Why do we often feel cut off when speaking to the people closest to us? What is it that keeps so many of us from really listening? Practicing psychotherapists, Donoghue and Siegel answer these questions and more in this thoughtful, witty, and helpful look at the reasons why people don’t listen. Filled with vivid examples that clearly demonstrate easy-to-learn listening techniques, Are You Really Listening? is a guide to the secrets and joys of listening and being listened to. [From the publisher, Sorin Books] List price new, appx. $16. ISBN: 1893732886.
What do family members, coworkers, and friends want most but seldom get? Your undivided attention. Poor listening can be a cause of divorce, depression, customer dissatisfaction, low grades, and other ills. This Zen-based, practical guide will help you build relationships, sharpen concentration, create loyal clients, strengthen negotiating skills, hear what others miss, and get them to hear.[From the publisher, Quest Books] List price new, appx. $16. ISBN: 0835608263.
In this thoughtful anthology, eighteen contemporary spiritual teachers explore the transformative effects, and the difficulties, of skillful listening and suggest ways in which becoming a ‘listening warrior’ — someone who listens mindfully with focused attention — can improve relationships. Free of religious dogma and self-help clichés, the essays are inspiring, intelligent and accessible. [from the back cover] List price new, appx $17. ISBN: 0861713559.
The following are criteria for Aspergers that have been excerpted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV):
Qualitative impairment in social interaction, as manifested by at least two of the following:
Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
lack of social or emotional reciprocity
Restricted repetitive & stereotyped patterns of behavior, interests and activities
The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
There is no clinically significant general delay in language
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment inchildhood.
They are often physically awkward and socially tactless.
You’ve probably known quite a few. Maybe they are even in your family. There’s that brilliant professor you had in college who looked at his desk the entire time he was talking to you and whose office was so overflowing with stuff there was nowhere for a visitor to sit. How about your brother-in-law the mechanic, whose work is superb but who insists on describing in minute detail exactly what he did to fix your car — and doesn’t seem to notice all your hints that you’re trying to leave already! What about your uncle or cousin or the sister of your best friend who is so socially awkward that you squirm with discomfort whenever they show up at an event, wondering what they’ll do next to embarrass themselves?
They are often physically awkward and socially tactless. They seem to be perfectionists but often live in chaos. They know more about some obscure or highly technical subject than seems possible — and go on and on about it. They may seem to lack empathy, and are often accused of being stubborn, selfish, or even mean. They can also be extremely loyal, sometimes painfully honest, highly disciplined and productive in their chosen field, and expert at whatever they decide to be expert at. They are the Aspies, adults with Asperger’s Syndrome.
The number of adults with Aspergers is still difficult to determine. The syndrome wasn’t even officially acknowledged in the DSM until 1994, even though it was described by Hans Asperger in 1944. The result? Many older adults weren’t diagnosed — or helped — as children. Teachers found them exasperating because they were so disorganized and uneven in their academic performance despite often being clearly bright. Other kids considered them weird and either bullied them or ignored them. As adults, they are only now discovering that there is a reason they’ve had difficulties with relationships their entire lives.
For many, having a diagnosis is a relief.
“I never could figure out what other people want,” says Jerome, one of my Aspie clients. “People seem to have some kind of code for getting along that is a mystery to me.”
Jerome is a brilliant chemist. He has the respect of his colleagues but he knows that he’s not well-liked. The finely tuned intuition he uses to do research breaks down completely in relationships.
“I know I’m well-regarded in my work. As long as we’re talking about a research problem, everything is fine. But as soon as people start doing that small talk stuff, I’m lost. It’s good to have a name for it. At least I know there’s a reason.”
Jerome is now starting to put the same intelligence he uses in his lab to learning better social skills. For him, it’s an academic problem to solve. Like many other Aspies, he wants to get along and have friends. He’s highly motivated to learn the “rules” most people take for granted. He just never understood what those rules were. Having the diagnosis has given him new energy for the project.
The press coverage of the syndrome of the last several years has been very helpful as well.
“I was working on a highly technical engineering project with a new guy last week. In the middle the morning, he put down his pencil, looked at me and said, “You have Aspergers, don’t you.”
Ted was explaining a recent encounter to me. “I got real nervous, thinking he was going to leave.”
“What did you say?” I asked.
“Well. I know now that’s my problem so I just said he was right. And you know what he said? He said, ‘I thought so’ and told me I could relax because he works with another guy who has the same thing. We had a great morning solving the problem. That wouldn’t have happened even a few years ago. I would have upset him somehow without understanding why. He would have gone back to his company thinking I was some kind of jerk. Things are just better now that there’s some understanding out there.”
Having the diagnosis has also saved more than a few marriages. Now that the kids are grown, Judy was ready to separate from her husband of 27 years when she first came to therapy.
“If Al and Tipper Gore could do it after 40 years of marriage, I figured I could manage it too. I don’t know what their problems were but I was just exhausted. I felt like I’d been single-parentingour two kids forever. Actually, I felt like I had three kids. Most of my friends couldn’t figure out what I saw in a guy who could only talk about one thing and who would rudely disappear in the middle of a social evening. He never seemed to be able to understand any of our feelings. Our finances were always a mess because he would lose track of bills. Yes, he was really sweet to me in our private life and he’s always been great about doing things like building the kids a tree house — that was really, really cool. But it became harder and harder to see that as a fair exchange for all the times I had to smooth things over because of something he did or didn’t do that bothered someone.
Then my daughter emailed me an article about Aspergers. It changed everything. I realized he wasn’t deliberately making life so hard. He couldn’t help it. As soon as he took an Aspie quiz online, he saw it was true. He does love us. He didn’t want the family to fall apart. He went right out and found a therapist who works with adults with Aspergers. He’s far from perfect but he’s honestly trying. He’s even apologized to the kids for not being more involved while they were growing up. I can’t ask for more than that.”
A diagnosis is primarily used to drive treatment decisions and to make it easier for clinical people to communicate with each other. But in cases like these, it can also be an enormous comfort to the individual and their families. As long as someone with Aspergers feels like they are being blamed or criticized for something they don’t even understand, they can only be defensive or bewildered. When the people around them feel offended or disrespected, they can only get exasperated, argue, or write them off. But when the thing that makes a relationship difficult is named and understood, it becomes a problem that can be worked on together. That shift can change everything.
Many services and a great starting point for addiction services in Ottawa.
Admission
We do our best to ensure that our potential clients receive timely access to our services.Using a brief pre-admission screening questionnaire, a staff member will verify the recent drug use of a prospective client and whether or not withdrawal in our non-medical centre is best suited for the individual. Occasionally we will refer a potential client to a medical facility or hospital if there are significant issues which might affect the safety of clients and staff.
After completing the screening questionnaire over the phone or in person, if our services are thought to meet the needs of the client and there is a bed available, a staff member and the client will agree on a time for the admission to take place. At admission, the client will be asked a few more detailed questions face-to-face, and then be asked to rest in the observation area for further monitoring.
For further information or to refer, please call 613-241-1525.
You enteredtherapyfeeling broken, lonely,anxious, dissatisfied with your relationships and your career. Now you feel whole and healthy; your relationships have improved, and you’ve made some professional changes that have led to a more fulfilling career. You feel good about yourself. Life isn’t perfect, but you have come to accept these imperfections, and you feel equipped to handle life’s challenges when they come your way. Congratulations! The time, effort, and willingness to openly and honestly explore the most complex and painful areas of yourself and your life have paid off. Therapy worked. Now what? You have a standing weekly appointment with your therapist, and you have probably developed a strong therapeutic alliance with him or her. But lately you have noticed that you don’t feel a need to go to therapy and you struggle to find ways to fill the hour. These are some strong indicators that you are ready to leave therapy.
For most people, therapy is not forever. Very few people have reason to be in therapy for life. In fact, many of the people who make therapy a way of life are therapists. They have a personal and professional responsibility to maintain high levels of self-awareness. They must take precautions to ensure that their issues are not getting in the way of helping their clients, and that they are not letting their clients’ issues prevent them from living their own lives. Weekly therapy sessions can create the time, space, and support for therapists to do just that.
Certainly, there are some people who are not therapists who also come to view therapy as a way of life. These people are often deeply dedicated to self-growth, and therapy may provide the support they need as they pursue constantly evolving personal goals. However, the vast majority of people who come to therapy do so with the intent of getting help with something specific. Whether it is something as broad as wanting to feel better or something as narrow as making a decision about a career move, people usually bring a specific goal to therapy. For some, these goals can be achieved in a few short months, while for others, it can take years. But ultimately there is a resolution and they feel ready to end therapy. Thequestion then is how to do it.
One of the things people find most useful about therapy is that there is nothing you can’t talk about in a session—including your relationship with your therapist. In fact, a growing body of research indicates that much of the positive change produced by therapy comes as a result of the therapeutic relationship. For example, if your relationships improved while you were in therapy, it is likely, in part, because you learned new ways of being in relationships by actively participating in your therapeutic relationship. So take the well-honed skill set that you developed in therapy and open a discussion with your therapist about ending the therapeutic relationship.
This will likely come as no surprise to your therapist. He or she knows what you came in to work on and knows that you have achieved your goal. Plus, this is a natural part of the process—all therapists in training learn about how to help clients work through this final stage, called termination. This is a prime opportunity to review the goals that brought you to therapy and to reflect on the growth that allowed you to accomplish them. This part of therapy is kind of like a graduation ceremony—it is an opportunity to step back, look at how far you have come, and revel in your success. And, as with graduations, it is an opportunity to ponder and plan for what comes next. Part of termination involves reinforcing the coping skills that evolve during therapy and reminding clients to continue to draw upon them in the future. Another important part of this process is to identify indicators that may signal the need to return to therapy in the future.
Finally, working through the process of termination with your therapist will allow you the opportunity to process the ending of a powerful and unique relationship. While this is a deeply genuine relationship, it is also one that exists within strictly prescribed boundaries—within the therapist’s office during appointment times. Of course, there may have been phone calls and additional meetings scheduled during times of crisis, but there isn’t a healthy way to continue the relationship you have formed with your therapist outside of therapy. Feelings of grief, loss, and anxiety about ending the therapeutic relationship often come up, and termination is designed to address these feelings. Like all aspects of therapy, this can be a difficult process, but seeing it through can be invaluable in helping you continue to develop and implement the kind of sophisticated relational skills that enable you to have deeper, more meaningful, and authentic relationships.
I remember being endlessly entertained by the adventures of my toys. Some days they died repeated, violent deaths, other days they traveled to space or discussed my swim lessons and how I absolutely should be allowed in the deep end of the pool, especially since I was such a talented doggy-paddler.
I didn’t understand why it was fun for me, it just was.
But as I grew older, it became harder and harder to access that expansive imaginary space that made my toys fun. I remember looking at them and feeling sort of frustrated and confused that things weren’t the same.
I played out all the same story lines that had been fun before, but the meaning had disappeared. Horse’s Big Space Adventure transformed into holding a plastic horse in the air, hoping it would somehow be enjoyable for me. Prehistoric Crazy-Bus Death Ride was just smashing a toy bus full of dinosaurs into the wall while feeling sort of bored and unfulfilled. I could no longer connect to my toys in a way that allowed me to participate in the experience.
Depression feels almost exactly like that, except about everything.
At first, though, the invulnerability that accompanied the detachment was exhilarating. At least as exhilarating as something can be without involving real emotions.
The beginning of my depression had been nothing but feelings, so the emotional deadening that followed was a welcome relief. I had always wanted to not give a fuck about anything. I viewed feelings as a weakness — annoying obstacles on my quest for total power over myself. And I finally didn’t have to feel them anymore.
But my experiences slowly flattened and blended together until it became obvious that there’s a huge difference between not giving a fuck and not being able to give a fuck. Cognitively, you might know that different things are happening to you, but they don’t feel very different.
Which leads to horrible, soul-decaying boredom.
I tried to get out more, but most fun activities just left me existentially confused or frustrated with my inability to enjoy them.
Months oozed by, and I gradually came to accept that maybe enjoyment was not a thing I got to feel anymore. I didn’t want anyone to know, though. I was still sort of uncomfortable about how bored and detached I felt around other people, and I was still holding out hope that the whole thing would spontaneously work itself out. As long as I could manage to not alienate anyone, everything might be okay!
However, I could no longer rely on genuine emotion to generate facial expressions, and when you have to spend every social interaction consciously manipulating your face into shapes that are only approximately the right ones, alienating people is inevitable.
Everyone noticed.
It’s weird for people who still have feelings to be around depressed people. They try to help you have feelings again so things can go back to normal, and it’s frustrating for them when that doesn’t happen. From their perspective, it seems like there has got to be some untapped source of happiness within you that you’ve simply lost track of, and if you could just see how beautiful things are…
At first, I’d try to explain that it’s not really negativity or sadness anymore, it’s more just this detached, meaningless fog where you can’t feel anything about anything — even the things you love, even fun things — and you’re horribly bored and lonely, but since you’ve lost your ability to connect with any of the things that would normally make you feel less bored and lonely, you’re stuck in the boring, lonely, meaningless void without anything to distract you from how boring, lonely, and meaningless it is.
But people want to help. So they try harder to make you feel hopeful and positive about the situation. You explain it again, hoping they’ll try a less hope-centric approach, but re-explaining your total inability to experience joy inevitably sounds kind of negative; like maybe you WANT to be depressed. The positivity starts coming out in a spray — a giant, desperate happiness sprinkler pointed directly at your face. And it keeps going like that until you’re having this weird argument where you’re trying to convince the person that you are far too hopeless for hope just so they’ll give up on their optimism crusade and let you go back to feeling bored and lonely by yourself.
And that’s the most frustrating thing about depression. It isn’t always something you can fight back against with hope. It isn’t even something — it’s nothing. And you can’t combat nothing. You can’t fill it up. You can’t cover it. It’s just there, pulling the meaning out of everything. That being the case, all the hopeful, proactive solutions start to sound completely insane in contrast to the scope of the problem.
It would be like having a bunch of dead fish, but no one around you will acknowledge that the fish are dead. Instead, they offer to help you look for the fish or try to help you figure out why they disappeared.
The problem might not even have a solution. But you aren’t necessarily looking for solutions. You’re maybe just looking for someone to say “sorry about how dead your fish are” or “wow, those are super dead. I still like you, though.”
I started spending more time alone.
Perhaps it was because I lacked the emotional depth necessary to panic, or maybe my predicament didn’t feel dramatic enough to make me suspicious, but I somehow managed to convince myself that everything was still under my control right up until I noticed myself wishing that nothing loved me so I wouldn’t feel obligated to keep existing.
It’s a strange moment when you realize that you don’t want to be alive anymore. If I had feelings, I’m sure I would have felt surprised. I have spent the vast majority of my life actively attempting to survive. Ever since my most distant single-celled ancestor squiggled into existence, there has been an unbroken chain of things that wanted to stick around.
Yet there I was, casually wishing that I could stop existing in the same way you’d want to leave an empty room or mute an unbearably repetitive noise.
That wasn’t the worst part, though. The worst part was deciding to keep going.
When I say that deciding to not kill myself was the worst part, I should clarify that I don’t mean it in a retrospective sense. From where I am now, it seems like a solid enough decision. But at the time, it felt like I had been dragging myself through the most miserable, endless wasteland, and — far in the distance — I had seen the promising glimmer of a slightly less miserable wasteland. And for just a moment, I thought maybe I’d be able to stop and rest. But as soon as I arrived at the border of the less miserable wasteland, I found out that I’d have to turn around and walk back the other way.
Soon afterward, I discovered that there’s no tactful or comfortable way to inform other people that you might be suicidal. And there’s definitely no way to ask for help casually.
I didn’t want it to be a big deal. However, it’s an alarming subject. Trying to be nonchalant about it just makes it weird for everyone.
I was also extremely ill-prepared for the position of comforting people. The things that seemed reassuring at the time weren’t necessarily comforting for others.
I had so very few feelings, and everyone else had so many, and it felt like they were having all of them in front of me at once. I didn’t really know what to do, so I agreed to see a doctor so that everyone would stop having all of their feelings at me.
The next few weeks were a haze of talking to relentlessly hopeful people about my feelings that didn’t exist so I could be prescribed medication that might help me have them again.
And every direction was bullshit for a really long time, especially up. The absurdity of working so hard to continue doing something you don’t like can be overwhelming. And the longer it takes to feel different, the more it starts to seem like everything might actually be hopeless bullshit.
My feelings did start to return eventually. But not all of them came back, and they didn’t arrive symmetrically.
I had not been able to care for a very long time, and when I finally started being able to care about things again, I HATED them. But hatred is technically a feeling, and my brain latched onto it like a child learning a new word.
Hating everything made all the positivity and hope feel even more unpalatable. The syrupy, over-simplified optimism started to feel almost offensive.
Thankfully, I rediscovered crying just before I got sick of hating things. I call this emotion “crying” and not “sadness” because that’s all it really was. Just crying for the sake of crying. My brain had partially learned how to be sad again, but it took the feeling out for a joy ride before it had learned how to use the brakes or steer.
At some point during this phase, I was crying on the kitchen floor for no reason. As was common practice during bouts of floor-crying, I was staring straight ahead at nothing in particular and feeling sort of weird about myself. Then, through the film of tears and nothingness, I spotted a tiny, shriveled piece of corn under the refrigerator.
I don’t claim to know why this happened, but when I saw the piece of corn, something snapped. And then that thing twisted through a few permutations of logic that I don’t understand, and produced the most confusing bout of uncontrollable, debilitating laughter that I have ever experienced.
I had absolutely no idea what was going on.
My brain had apparently been storing every unfelt scrap of happiness from the last nineteen months, and it had impulsively decided to unleash all of it at once in what would appear to be an act of vengeance.
That piece of corn is the funniest thing I have ever seen, and I cannot explain to anyone why it’s funny. I don’t even know why. If someone ever asks me “what was the exact moment where things started to feel slightly less shitty?” instead of telling a nice, heartwarming story about the support of the people who loved and believed in me, I’m going to have to tell them about the piece of corn. And then I’m going to have to try to explain that no, really, it was funny. Because, see, the way the corn was sitting on the floor… it was so alone… and it was just sitting there! And no matter how I explain it, I’ll get the same, confused look. So maybe I’ll try to show them the piece of corn – to see if they get it. They won’t. Things will get even weirder.
Anyway, I wanted to end this on a hopeful, positive note, but, seeing as how my sense of hope and positivity is still shrouded in a thick layer of feeling like hope and positivity are bullshit, I’ll just say this: Nobody can guarantee that it’s going to be okay, but — and I don’t know if this will be comforting to anyone else — the possibility exists that there’s a piece of corn on a floor somewhere that will make you just as confused about why you are laughing as you have ever been about why you are depressed. And even if everything still seems like hopeless bullshit, maybe it’s just pointless bullshit or weird bullshit or possibly not even bullshit.
I don’t know.
But when you’re concerned that the miserable, boring wasteland in front of you might stretch all the way into forever, not knowing feels strangely hope-like.
” data-recalc-dims=”1″ data-lazy-src=”https://rorybatchilder.com/files/2012/10/pagevfdcvd-resize-840-267-is-pending-load-1.jpg” srcset=”data:image/gif;base64,https://rorybatchilder.com/files/tag/r0lgodlhaqabaiaaaaaaap///yh5baeaaaaalaaaaaabaaeaaaibraa7″>Written by Michelle H Lim, Swinburne University of Technology
My Nervous Breakdown
I’ve skirted, danced, bogled and boogeyed around it and kinda explained why it happened but never really gone into much “depth” as to – what happened, how it happened, how it felt – so I’m bored, have a few hours, am tired of talking to Meadhbh so am gonna blabber here for a while.
What is a “nervous breakdown”?
You could also call it an emotional breakdown or perhaps a mental breakdown, but in essence a “breakdown” has occurred when someone becomes unable to deal with normal day-to-day life.
It can be ignited following a particular trauma, a series of events, or can even happen randomly and out of the blue with no precipitating identifiable cause.
“Nervous breakdown” isn’t even a medical term: it’s a colloquial phrase designed to try and hide what is actually happening, which is the sudden acute attack of a mental illness, because a breakdown is far more easily accepted than bipolar, depression or anxiety; it is stigma at work!
Why I had a breakdown…
A breakdown generally occurs when your circuits become overloaded. Your brain, heart, soul, emotions – whatever – are under so much stress that they short circuit, and then shut off, and then you can’t find a nice clean unbroken fuse to mend them.
As mentioned previously, I was diagnosed with CLL and then dumped by my girlfriend by text message which set in motion a chain of events which caused me to lose my college course, my income, my best friend and all of this happening whilst I was suffering from glandular fever – a pretty serious physical illness which could have killed me – and all in the period of ten days.
I think any one or two of those things could have the power to trigger a breakdown, but to have so many stressful emotional events hitting you when you are already physically, mentally and emotionally devastated from glandular fever, the fact I had a breakdown doesn’t surprise me.
What happened?
The day I realised something was seriously wrong was the Tuesday I spent walking around the sleepy hamlet of Port Fairy talking to myself at an audibly obvious level for six continuous hours before sitting on a beach and burning myself with a flaming stick. Now I had wanted to phone someone at this point, I knew something was brewing and I was worried I wasn’t going to be able to stop myself…but no working public phone box anywhere close and…dammit…mobile phone battery was dead!
So I burnt myself twice, used the ocean to cool the burns, and then stood there for an hour or so staring at the black expanse of the horizon before retreating to where I was staying whilst I was in Port Fairy.
I spent the next day glued to the bed, unable to move, writing obscure journal entries which skipped, danced and evaded the actual events which had happened the night before. I thought that by not writing about them I would be able to forget them. I watched an entire season of 24 that day and wished to high fracking heaven my mobile phone charger had been packed because at this point I really desperately needed to speak to someone. Oh well.
On the Thursday I crawled to the Doctor, on the Friday I saw a psychologist, on the Saturday I sat on a beach again, on the Sunday I spent another 7 hours walking around talking to myself, on the Monday I returned to Melbourne.
How did it feel to have a breakdown?
I literally felt nothing. I literally could do nothing. There was all this stuff I needed to do, all this stuff I wanted to do, but I just – couldn’t – I literally could not do any of it. My brain was not functioning on any level, all I could do for a few days was lie there watching other seasons of 24 (as this had helped the week before) trying not to harm myself.
Now that I had my charger back I couldn’t even bring myself to phone anyone because I didn’t have any words to say. I was doing that wee dial the number, delete the number, toss the phone across the room dance.
On the Wednesday I woke up having a panic attack, spent the day in a constant state of anxiety, panic, despair and fear. I wrote in my journal on and off, and for the first time ever mentioned my self harm in it’s pages (which you can read here). Then something happened that night which – well – let’s just say really really really really didn’t fracking help!!! I have never understood why that person thought it was a good idea, never will, but what they did that night was fucked up to the extreme!
On the Thursday I wanted to kill myself. I sat on the floor of my room staring at a knife and wondering what it would feel like. Tears were streaming down my face and I know I made two phone calls, but I can’t remember which order they came in. I either phoned a friend and then the suicide helpline, or I phoned the suicide helpline and then phoned a friend. Either way I spent the vast majority of that day in a constant state of fear of what I may do to myself.
After that week the specific days become blurry, everything is just a mess in my mind. I know I fought my self harm tendencies, I know Meadhbh came back, I know I did self harm, I know I was suicidal, I know I saw friends, I know I tried to rebuild my life, I know I saw doctors, I know I saw the occasional psychologist, I know I tried to do anything and everything that I could to fight what was happening to me and get my life back to something I was able to enjoy.
I wasn’t able to work. That’s a fact. Simple and pure. My health was fucked up to the point of unbearable, I couldn’t concentrate on a job advertisement let alone work an 8 hour shift, but I job hunted nonetheless.
As all this was happening I was having to sell all of my possessions in order to survive (rent, food, occasional social outings or cinema trips to make myself feel normal, which I would have to plan in advance in order to have the strength to do it without a panic attack) and try not to tell any of my friends what was really happening because, well, you have to pretend and not ever talk about your problems or negative incidents remember! Internalise, never externalise, because it was attempting to externalise that contributed to the problem in the first place!
My decision making capacity was shot to fuck, my conversational ability had gone; anxiety, depression, suicidal inclinations and self harm reigned supreme. The fact I had overcome all of this only a few months before contributed to the continuation of my depressive episode – all of those years of work for nothing!
My conversations with Meadhbh were driving my ever more insane, my ex was driving me nuts with her consistent emotional/psychological abuse, which Meadhbh was loving because it backed up everything she was telling me. Meadhbh would often say something which my ex would then reiterate word for word a few weeks later; “You have to help people,”, “You’re selfish,”, “You should kill yourself,”, “You never care about anyone!” oh how Meadhbh loved those moments!
Physically I was a wreck; fighting glandular fever was made almost impossible and my recovery time was lengthed by months. I had chronic pain in my back, splitting migraines, I wasn’t able to sleep and never felt hungry. I had to go to hospital several times for a recurring polynoidal sinus, though unrelated to the breakdown, has been recurring ever since due to the stress I have been under and have been waiting for an operation to have it removed. The meds I was on threw all sorts of side effects in my direction, which further messed with my body (and mind) and viruses seemed to claim their hold on my body on a regular basis.
I don’t think anyone can truly understand what having a breakdown feels like unless they have experienced one. Like depression “breakdown” is an overused word and does not in any way fully describe the pain and torment your mind is constantly under. You literally cannot function on a normal day-to-day level; your body is besieged with physical pain and your mind is engulfed with the sort of emotional pain I would never wish on anyone.
Overcoming a breakdown…
Like with all forms of mental illness there is only so much help you can garner from other people. You can see doctors and psychologists and MH professionals but you still have to do a hell of a lot of work yourself. I saw my GP regularly and fought for months for professional mental health care, which even after two suicide attempts only really came a few weeks ago.
So how can you help yourself fight an emotional breakdown? These are some of the things I tried:
Be kind to yourself! You are going to have bad days and you are going to have good days. Don’t berate yourself for the bad days and think of yourself as a failure as this will only feed the breakdown demons.
Find ways to reduce your stress level… – Eat healthily; brown rice, fruit, vegetables, natural foods…
– Find ways for regular relaxation (I used to walk, play in parks in the night-time, sit under trees, watch movies, write [we’ll get to that in a minute])
– Have baths!
– Try to socialise with friends and do things you enjoy (trivia nights, movies, coffee and tea, pizza lunches)
– Do regular relaxation exercises.
– Keep a daily ‘things to do list’ to refer to.
Be physical Regular exercise and activity helps relieve stress and tension and keeps your body fit and active, in can be hard to do this after having a breakdown or going through a depressive phase, but it is important. Walking, swimming, cycling, yoga, pilates…if you do something you enjoy it will make things easier.
Research and learn about what is happening to you. Understanding your problems/illness better may make it easier to cope.
Find your own coping strategy Everyone is different, what works for one person will not work for another. So find your own ways to deal with what you are feeling and your own techniques to get you through your bad days.
– Writing is something I did, the vast majority of my novel “The Ghosts that Haunt Us” was written during this period. However, in order for me to achieve the state of mind I needed to be in, in order to write, I had to self-harm (sometimes severely) in order to get there.
– Other people find art, music, drawing or poetry effective.
– To get through the bad periods I would play video games. I’m a Zelda aficionado so would replay my Gameboy Zelda games to occupy my mind.
– Meditation and yoga can help.
– Although I was unable to write a journal (still can’t to this day, won’t go into why), I did keep a mood diary to help identify and chart what I was feeling.
There are lots of ways you can find to cope with what is happening. I would be interested in hearing your own coping strategies as they may help other people.
Relationships and Friendships following a breakdown… One of the hardest things I had to deal with was being told repeatedly that who I thought were my friends were not really my friends (an example of being isolated by my abuser) and wouldn’t be there for me. Thus I was unable to talk to them about what I was going through as I was afraid of pushing them away – which was inevitably going to happen anyway – so had to fight my breakdown alone. They knew I had had a breakdown, and self harmed to some extent, but were not aware of the full extent of what I was dealing with.
After a breakdown your self confidence and self worth will be virtually non-existent, thus your ability to retain friendships and relationships will be put under further strain. As you are not thinking clearly your actions may cause harm to those people you care about, even if it is inadvertent, so you may need to apologise for anything which happened during the breakdown and work on rebuilding those friendships.
Although you will need to work out whether the problem was caused by you, or by them, if it was their problem they will need to find a way to deal with it as you should not have to accept responsibility.
I can’t sit here and talk about friendship really, I don’t have any, and as I am still fighting my breakdown cannot give profound advice on healing rifts and repairing damage.
I will say however that, like everyone, a show of kindness and love can help someone who has suffered from a breakdown. We all want to feel loved, we all need kindness, to help us get by.
Can you overcome a nervous breakdown?
The breakdown I experienced earlier this year was singularly the most painful, distressing, chaotic and fear inducing period of my life. I literally just could think straight in any way, my brain shut down and wasn’t functioning on any level. It was a constant daily fight to get through each conversation, each hour, each day.
The road to recovery following a nervous breakdown is hard work, it could take anywhere from 6 months to 3 years to fully recover. It can be done however, it’s not going to be easy, pretending it isn’t there won’t help but just cause longer term problems, it’s going to be painful, destructive and the hardest fight of your life.
If you’ve had time away from work, or have been long term unemployed due to mental or emotional health problems, you’re not alone. Almost 50% of long-term absences from work are due to mental health issues, including depression, anxiety and bipolar disorder.
People who have had a mental health problem and been out of work often worry about going back. Common concerns include facing discrimination or bullying, and going back too soon and feeling unwell again.
According to a recent report by the Royal College of Psychiatrists on mental health and work, “…many people with mental health problems fear that, no matter how good a recovery they have made, their symptoms will be made worse by going back to work.”
However, although work can cause stress to some people in some situations, recent research shows that for most people:
Work is beneficial to health and wellbeing.
Not being in work is detrimental to health and wellbeing.
Re-employment after a period of being out of work leads to an improvement in health and wellbeing.
The benefits of being in work can include:
a greater sense of identity and purpose
an opportunity to build new friendships
an improved financial situation and security
a feeling that you’re playing an active part in society
Going back to work after a period of ill health is usually a positive experience. This applies to people who have had severe mental health problems, such as bipolar disorder, as well as people coping with more common issues such as anxiety.
Returning to your job after taking sick leave
You don’t have to be 100% better or well to do your job, or at least some of it, and the benefits of returning to work generally outweigh the downsides.
If you already have a job that is still open for you, talk to your GP about going back to work. They can give you advice as part of your fit note. The fit note includes space for your GP to give you general advice about the impact of your illness, and to suggest ways in which your employer could support your return to work.
You may then like to arrange a meeting with your employer and/or your occupational health advisor. You can discuss anything that concerns you about returning to work, including your GP’s recommendations, and ask for some adjustments to make the transition back into work easier. Under the Disability Discrimination Act (1995) and the Equality Act (2010), your employer has a legal duty to make “reasonable adjustments” to your work. Depending on your particular circumstances, you might like to ask about:
Flexible hours, for instance you might like to return part-time, or start later in the day if you’re sleepy from medication in the mornings.
Support from a colleague, in the short or long term.
A place you can go to for a break when needed.
Access to Work
The Government provides support to help people with mental health problems continue to work, or find a new job.
You can find out more about the Access to Work scheme on the GOV.UK website. An Access to Work grant helps pay for practical support so that you can continue to do your job.
Looking for a new job
If you’re unemployed and want to get back into work, staff at your local Job Centre, your GP or your mental health worker can all give you advice about getting back into work.
If you have ongoing mental health issues, you can speak to the Disability Employment Advisor at your local Job Centre. They can tell you about the opportunities that are available to help people with mental health problems get back to work.
There are a number of different issues to consider and research when you’re thinking about getting back to work, including:
where you would like to work
what kind of work you’d like to do
what type of support you may need
your current financial situation, including any benefits you’re receiving related to your health
Full-time paid employment is not the only option available to you. There are a number of possibilities that may suit you, such as part-time work, or volunteering.
Volunteering
Volunteering is a popular way of getting back into working life. Helping other people in need is great for your self-esteem and can help take your mind off your own concerns. Plus, volunteer work can improve your chances of getting a paid job when you’re ready, and until then you can continue to claim your benefits. Find out more about how to volunteer.
Your rights and the law
Some people worry that when they apply for a job, they’ll be discriminated against if they admit that they have, or have had, mental or emotional health problems.
However, new provisions in the Equality Act 2010 make it illegal for employers to ask health or health-related questions before making a conditional offer of employment. Furthermore, it is illegal under the Equalities Act to discriminate against any kind of disability, including mental health issues.
I suffered a nervous breakdown at age 36 – and it turned out to be a breakthrough. Here are 15 important things about life and happiness that I have learned, and that I hope you will take to heart in the coming year.
I want you to do me a favor. Look to the upcoming year and ask yourself – realistically – what lies in store in 2012? If you’re like most people, a huge portion of your life will be spent anxiously plugging away at a job you may or may not enjoy with coworkers you may or may not like. Okay, yes, you work hard to build a better life for your family. But here’s the question: Will you have time to enjoy them? Will you be too exhausted to throw the ball with your son? And how many nights will you get home too late to tuck him in this year?
This pattern of stress and striving has to stop. We already live in uncertain and depressing times, and our lifestyles are driving us not toward new heights, but over the brink. And if you’re not careful, you may suffer the same fate I did.
When I was 36 years old, I was successfully leading my family’s auto parts business, I was well respected in my community, I had a wonderful wife and son… and I also suffered a nervous breakdown. Yes, at that point in my life, I enjoyed what I did and was truly proud of my successes, but I was also pushing myself too hard and prioritizing the wrong things, and eventually, it all caught up with me.
For months leading up to my breakdown, I suffered from a paralyzing depression and anxiety, and found it difficult to complete tasks as simple as deciding whether to order coleslaw or potato salad with my lunch. But I still consider myself to be very fortunate.
As horrific as it was, my breakdown was actually also my breakthrough. It was an in-your-face wake-up call that forced me to realize that I was driving myself too hard, and for the wrong reasons. I finally had to say, “Enough is enough! I am done destroying myself and ruining my life!” Admitting to myself that my former way of life wasn’t working was the beginning of my road to recovery and true happiness.
For the past decade, I have taken a closer look at what really makes people happy and unhappy, and I have seen most of my goals and priorities shift. In the same way, it’s in your best interests to shift your habits and focus in 2012. Call it a New Year’s resolution to simply be happy.
I have come to realize that how happy and fulfilled you are is largely under your control, and that it has less to do with success and accomplishments than you might think. I believe that most people are experiencing many – if not all – of the stressors that led to my breakdown, so please don’t wait until you, too, reach a breaking point to make changes in your life. I’m totally convinced now that true happiness is a possibility for everyone, so I’m asking you to take the lessons I have learned to heart.
If you’re ready to change the way you approach life before you drive yourself over the edge, read on for 15 life lessons that I have learned:
1. You have to choose and prioritize happiness – it doesn’t just happen. If you subscribe to the belief that your happiness is wholly dependent on what happens to you, you’ll always be dissatisfied. The truth is, your fulfillment largely depends on the choices you make: how you see the world, what you allow to influence you, what you focus on, and how you react to circumstances, regardless of whether they’re good or bad. In other words, it’s not what happens to you; it’s how you look at what happens to you.
If you want to make a dent in your stress levels, you have to make choosing happiness a priority every day. With all of the responsibilities on our plates, nothing is likely to happen unless we specifically focus on it. So make happiness one of the two or three priorities you absolutely must accomplish each day. To remind yourself, put a note where you can see it – maybe on the refrigerator or bathroom mirror. And if that sounds selfish, it’s not. If you’re extremely stressed or become depressed because of the way you’re living your life, you’re hurting many more people than just yourself. And what’s more important than teaching your kids to be happy? Always remember that children learn by example. If they see you living a harried, stressed life, that’s the pattern their lives will follow as well…and their children’s after them, and so on.
2. Striving for work/life balance is worth its weight in gold. Times are tough, and some of us are finding it necessary to work long hours to keep our jobs and livelihoods. Others have fallen into the trap of the work-ego addiction: over time, you become hooked on the “high” you feel when you accomplish something, get a promotion, etc., and you begin to spend more and more time at the office. Whatever the reason, if extremely long hours are becoming a habit for you, break it. No matter how good your intentions are, overloading on work will cause your relationships, mindset, and even health to suffer.
Prior to my breakdown, it was normal for me to work seventy- or eighty-hour weeks. In my personal dictionary, “rest” and “relaxation” were synonymous with “irresponsibility” and “slacking.” Boy, was I wrong. Working as much as I did is more than the human body is designed to take continuously. If you drive yourself that hard, you’ll eventually begin to run on fumes before you shut down entirely. Being firm about creating and maintaining a healthy work/life balance is no more selfish than prioritizing happiness – in this case, it’s about simple self-preservation! And if you’re still skeptical, remember this: no one looks back on their lives at age eighty and says, “Gee, I wish I’d spent less time with my family and friends and more time at the office.”
3. We are our own worst critics. If you’re like most people, you probably tend to focus a lot of your mental energy on the things you mess up rather than on the things you do well—even though most of us do a hundred things right for every one thing we do wrong. And although you may not realize it, focusing on that one wrong thing is very dangerous, because our thoughts are incredibly powerful. Until you give yourself permission to break free of the cycle of self-blame and negativity that causes you to be stuck demanding perfection from yourself in every situation, you’ll never have a chance to be a truly relaxed, content, and happy person.
It’s not easy to rewire your habitual thought processes, but you need to build yourself up more and beat yourself up less. I used to expect nothing less than perfection out of myself, which was delusional! We’re all human, which means that we’re going to make mistakes from time to time. That doesn’t mean that we’re in any way unworthy or undeserving of love. In fact, learning to love myself was at the core of my own happiness journey. If you aren’t satisfied with who you are, you’ll always be looking outside yourself for validation…and you’ll never be truly content. And like me, you might also push yourself beyond healthy limits in order to get accolades from other people.
4. It’s never too late to start living in the present. How often do your thoughts “live” in the present? More to the point, how often are they instead fixated on your “disappointing” or “disturbing” past or spent worrying about your future? If you are like most people, your percentage of time not spent in the present is way, way too high, and thus you’re missing out on life itself. If you’re letting what’s already happened eat away at you or fretting about what might come to pass, you’re not enjoying the blessings all around you. You’re exacerbating your anxiety and unhappiness by choosing to dwell on things you can’t change or control.
I used to spend a majority of my time rehashing my past mistakes and worrying about what might happen in the future, neither of which did anything for my peace of mind or self-esteem. In fact, these unhealthy and self-critical thoughts were a major contributor to my breakdown. Now that I’m making a conscious effort to live in the present, I’m actually enjoying all of the great things in my life instead of letting them pass me by unnoticed. Plus, I’m actually a lot more productive now that all of that mental space that used to be occupied with worries has been freed up!
5. Focusing on what you’re good at is best for everyone. If you aren’t good at something – especially if it’s work-related – chances are you’ll feel compelled to spend a lot of time and effort getting your skills up to par. It’s natural to want to shore up your weaknesses, but the fact is, this strategy tends to cause you a lot of stress for (most likely) mediocre results. Instead of trying to be good at everything, stay in your strengths as much as possible. When you’re doing what you’re good at, you’ll be happier and higher performing.
As I’ve said, I used to be a total perfectionist. I felt like I was a failure if I didn’t excel in absolutely everything I tried. It probably won’t be a surprise to hear that all I accomplished was making myself miserable when I failed to live up to my impossibly high standards. If that sounds familiar, I’d suggest focusing more time on a hobby or personal interest to start, even if you do it for only twenty minutes every other day. And if you determine that your career doesn’t utilize your strengths, start looking at online job postings or for local classes in your field of interest. It’s never too early—or too late—to start doing the things that make you happy.
6. Exercise is worth its weight in therapy. Yes, you’ve heard it (a million times) before, but exercise is one small change that yields really big, life-changing benefits. For starters, it will begin to make you feel more relaxed, stronger, and more capable of handling life’s challenges—also, it will improve your sleep, and it’s a natural anti-depressant that will help your attitude and outlook. In fact, exercise actually opens you up to future change by invigorating your mind and body.
I’m convinced that exercise is the single most important thing you can do to improve your life right now. Looking back, I believe that my breakdown occurred when it did because I had broken my feet and couldn’t work out. Before that point, exercise was essentially acting as a medication that helped to counteract the effects of the stressful lifestyle I was living, and after I recovered, it has continued to boost my energy and outlook. If working out is already a part of your life, great! If it isn’t, commit to walking just twenty minutes every other day to start out. You don’t have to join a gym, sign up for exhausting classes, and completely reorder your life to reap the benefits of this investment!
7. You need to feed your mind healthy ‘food.’ When was the last time you watched the nightly news and turned off the TV feeling positive and uplifted? If anything, hearing the headlines is more likely to be depressing and discouraging. Although many of us don’t want to admit it, the things we hear, read, and experience influence our own attitudes and outlooks, so it’s important to consciously “feed” your mind positive materials.
It may sound hokey, but over the years I’ve become a big proponent of motivational books, audio recordings, and DVDs. Whether we’re at work, talking with friends, or at home watching TV or surfing the web, most of us encounter a lot more bad news and predictions than we do good. No wonder we become negative and cynical! It’s important to seek out positive things that will counteract these influences and dispel unnecessary stress. Learn new, constructive things and expose yourself to fresh ways of thinking so that you don’t get stuck in a self-destructive rut.
8. Surround yourself with positive people. If you stop for a drink at the water cooler and find your colleagues griping about how much work they have to do and how unreasonable your boss is, you probably don’t think much of it. In fact, depending on how your own day is going, you might even join in. And although you may not realize it, your attitude will start to deteriorate. The fact is, if you spend a significant amount of time around other people who are negative, your own outlook will begin to mirror theirs.
It’s much easier for others to drag you down than it is for you to build them up. In terms of your attitude and happiness levels, you will be the average of the five people you spend the most time with, so you need to be around other people who share your commitment to happiness if you want to avoid unnecessary stress. I’m not suggesting that you completely sever relationships that aren’t entirely uplifting, but gradually, you need to gravitate more toward positive people and distance yourself from those who tend to bring you down. This might mean calling a positive friend and asking to meet up for coffee or a beer, or walking away from the water cooler when your coworkers begin to gripe and complain.
9. Invest in your relationships – especially your marriage. When we’re driving ourselves to the brink, personal relationships are usually one of the first things to suffer. After all, the more time you spend at work, the less time and energy you have to invest in friends and family. You don’t consciously realize it at first, but this gradual deterioration can leave you feeling unappreciated, angry, alone, and anxious. Remember, though, that loving, supportive relationships will majorly enhance your happiness levels, and that friends and family care about you and accept you in a way that your employer never will.
It’s never a waste of time to reach out to the people who are meaningful to you and tell them how important they are to you, or to try to address any unresolved grievances and apologize for the things you may regret. And there’s one relationship you need to focus on in particular: the one with your spouse or significant other. Put more work into this relationship than you do into anything else: your house, your car, or your job, etc. Celebrate your spouse every day. Tell her (or him!) all the time how beautiful she is and how lucky you are to have her in your life. Trust me: this can make such a great difference in your emotional health, your stress levels, and your overall happiness! I truly believe that I would not be as happy as I am today without the love of my wife, and I also believe that my breakdown would have been much worse without her support.
10. Take control of what you can. If you’re reading this, chances are your life isn’t exactly stress-free. It’s practically impossible to live in the modern world without a million worries ranging from work deadlines to bills to clogged gutters. While you aren’t omnipotent, you probably can influence at least a few of the things that are causing your anxiety. Try to eliminate or minimize situations that are stressors instead of constantly dealing with their effects. Often, it’s the little things that make the biggest difference when it comes to relieving stress.
Start by identifying the two or three things that cause you the most stress on a consistent basis – maybe having a messy house is one. Often, you’ll find that there are concrete things you can do to lessen or even eliminate the pressure. For example, you might have a frank discussion with your spouse and kids regarding chores. Or, you might finally hire a cleaning person to help you once or twice a month if you can now afford it. Also, if you can’t eliminate or change a stressor, such as a job you hate but can’t afford to quit, challenge yourself to handle it differently. Specifically, decide beforehand how you will react in a more enlightened way when certain stressful situations occur – actually visualize yourself handling them with poise instead of becoming outwardly or inwardly worked up. Having a game plan in place before the “beast” rears its ugly head really can reduce your negative reactions to stressors—big time.
11. Being friendly is a good investment. In our culture, it’s become a badge of honor to stride around with an air of importance and a stony face. After all, if you’re too busy to say hello, you must be important. Yes, it’s easy to become absorbed by your responsibilities – but you’re not doing yourself any favors by shutting out the rest of the world. Even if you don’t have time to answer all of your emails, you can still smile at people in the hall and say a friendly hello to the cashier in the grocery store. Making positive connections will bring more happiness to you and to others.
Have you noticed that although our society is more and more “connected” by technology, we interact less and less with other people on a meaningful, face-to-face level than ever before? Our plugged-in lifestyles aren’t doing us as many favors as we thought they would. Even when we’re not at work, we’re likely to be glued to our smartphones or laptops, which amps up our stress. Make a conscious effort to unplug and make a friendly connection with another human – even a simple smile or hello is great. The fact is, everyone on Earth is carrying some sort of burden. You can’t make their pain, stress, or grief just magically disappear…but you can be what I call a “lamp-lighter” – someone who makes others feel just a little bit lighter and happier on their journey, even if only for five seconds. When you make friendliness a habit, you’ll attract kindness and smiles in return…and you’ll feel great about yourself for making a positive difference in the world!
12. Helping others is the soul food of life. One of the (many) negative side effects of our busy lives is that we tend to think mostly about ourselves: how much work we have left on that big presentation, how we’re going to find time to take the kids to sports practice and pick up groceries, and much, much more. No matter how busy you are now, consider helping others to be an integral part of the healthy work/life balance that will help you to avoid unhappiness. This will give you perspective, make you feel good, and will prevent you from staying in the negative me-focused cycle that was making you unhappy in the first place.
Since my breakdown, I’ve become very involved in philanthropy. I’ve found that it really is better to give than to receive, and that reaching out a helping hand to someone who isn’t as fortunate as you tends to quash selfish impulses and highlight your own blessings. Giving of yourself doesn’t have to involve money, either – remember that your time, talents, and compassion are just as valuable as cash, if not more so. Consider visiting a disabled veteran at the VA, or simply rolling your neighbor’s trashcan up the driveway! And if you have kids, you’ll be setting a wonderful example for them. I promise you, whether you’re giving time, energy, money, or encouragement, being generous will build up your self-esteem, broaden your perspective, keep you anchored in reality, and connect you to your blessings – all components of a happy life.
13. It’s important to connect with something bigger than yourself. Yes, spirituality (much like politics) is a touchy subject. But believing in something bigger than yourself is essential to developing the kind of perspective you need to be happy. Whether you consider your Higher Power to be God, Yahweh, Allah, Buddha, Krishna, the Universe, or even just Nature or another entity, being willing and able to see and feel His (or Her, if you prefer!) presence in your life will enable you to move away from self-centeredness and focus your energy and concerns on the greater community. It’ll also provide solace and give meaning to unfortunate events and troubling life circumstances.
Personally, I’ve been connected to the Jewish faith for my entire life. But it was only after my breakdown that I really allowed my faith to grow. My personal belief that God exists and cares about me has changed the way I view the world—but you don’t need to espouse my beliefs, or even join an organized religion and attend services regularly. What I do hope you’ll do is make an effort to clarify your thoughts about faith and also make an effort to connect to your Higher Power, whether it’s through prayer, meditation, writing in a journal, doing random acts of kindness, or just spending time in nature. Eventually, I hope you’ll begin to see your Higher Power as a source of inspiration, renewal, strength, guidance, and aid – as I do.
14. A grateful heart is a happy heart. It’s very easy to take things for granted: the information your coworker emailed you, the fact that your car is running, and even the food you’re eating for dinner. The fact is, most of us have gotten into the habit of ignoring all of the good things in our lives. Instead, we focus our mental energy on being upset about what’s wrong and what we don’t have. Yes, cultivating an “attitude of gratitude” might be a clichéd concept, but the humility that comes from knowing you owe so much to so many others will, in turn, spur you to give back more often to those less fortunate than yourself. Plus, studies have actually shown that thankful individuals are 25 percent healthier than their counterparts, too!
To start tapping into the power of gratitude, just say “thanks” to the people who help you out during your day. And beyond that, try to notice all of the blessings in your life. If you live in America, you have access to great education, healthcare, and the freedom to worship and work as you choose. Those are huge things to be thankful for right out of the gate! We take these “basics” and much more for granted, and we often have others—whether it’s an ancestor of ours, a veteran, or a coworker—to thank for them. It’s extremely important to be aware of all of your blessings, and to honor and thank those whom you owe.
15. Asking for help isn’t a sign of weakness. All of the things I have learned from my breakdown will help you to cut your stress levels, and they’ll also aid you in cultivating a more balanced, happier life. But it’s also important to realize that feeling anxious, overwhelmed, or depressed are all very serious, and you shouldn’t expect yourself to easily “fix” these issues on your own.
If you feel that you’re in over your head, or if your best efforts aren’t working, please reach out and ask for help. I might never have recovered after my breakdown without the help of my friends, family, and medical professionals. This is all big stuff. You shouldn’t—in fact, you can’t—make big changes in your life alone. At the very least, you’ll need the support of those who love you.
Ultimately, I’ve learned that the quality of your life is largely up to you. If you’re anything like me – and if you’re honest with yourself – you’ll have to confess that a striving, stressful lifestyle is not making you happy. I’ll admit that many of the changes I’m asking you to make in order to avoid more unhappiness (and perhaps even a breakdown) go against what society says you should do if you want to be successful. But I have found out the hard way that a “successful” yet stressed out and unhappy life is certainly not, in reality, a truly successful life at all.
Todd Patkin is the Author of Finding Happiness: One Man’s Quest to Beat Depression and Anxiety and – Finally – Let the Sunshine In (StepWise Press, 2011, ISBN: 978-0-9658261-9-8, $19.95). The book is available at bookstores nationwide, from major online booksellers, and at www.findinghappinessthebook.com.
by Edward M. Hallowell, M.D. and
John J. Ratey, M.D.
The treatment of adult ADHD begins with hope.
We break down the treatment of adult ADHD into five basic areas:
• Diagnosis
• Education
• Structure, support, and coaching
• Various forms of psychotherapy
• Medication
Following are 50 Tips for the non-medication treatment of ADHD:
Insight and Education
1. Be sure of the diagnosis. Make sure you’re working with a professional who really understands ADHD and has excluded related or similar conditions such as anxiety states, agitated depression, hyperthyroidism, manic-depressive illness, or obsessive-compulsive disorder.
2. Educate yourself. Perhaps the single most powerful treatment for ADHD is understanding ADHD in the first place. Read books. Talk with professionals. Talk with other adults who have ADHD. You’ll be able to design your own treatment to fit your own version of ADHD.
3. Coaching. It is useful for you to have a coach, for some person near you to keep after you, but always with humor. Your coach can help you get organized, stay on task, give you encouragement or remind you to get back to work. Friend, colleague, or therapist (it is possible, but risky for your coach to be your spouse), a coach is someone to stay on you to get things done, exhort you as coaches do, keep tabs on you, and in general be in your corner. A coach can be tremendously helpful in treating ADHD.
4. Encouragement. ADHD adults need lots of encouragement. This is in part due to their having many self-doubts that have accumulated over the years. But it goes beyond that. More than the average person, the ADHD adult withers without encouragement and positively lights up like a Christmas tree when given it. They will often work for another person in a way they won’t work for themselves. This is not “bad”, it just is. It should be recognized and taken advantage of.
5. Realize what H is NOT, i.e., conflict with mother, etc.
6. Educate and involve others. Just as it is key for you to understand ADHD, it equally if not more important for those around you to understand it–family, job, school, friends. Once they get the concept they will be able to understand you much better and to help you as well.
7. Give up guilt over high-stimulus-seeking behavior. Understand that you are drawn to high stimuli. Try to choose them wisely, rather than brooding over the “bad” ones.
8. Listen to feedback from trusted others. Adults (and children, too) with ADHD are notoriously poor self-observers. They use a lot of what can appear to be denial.
9. Consider joining or starting a support group. Much of the most useful information about ADHD has not yet found its way into books but remains stored in the minds of the people who have ADHD. In groups this information can come out. Plus, groups are really helpful in giving the kind of support that is so badly needed.
10. Try to get rid of the negativity that may have infested your system if you have lived for years without knowing what you had was ADHD. A good psychotherapist may help in this regard.
11. Don’t feel chained to conventional careers or conventional ways of coping. Give yourself permission to be yourself. Give up trying to be the person you always thought you should be–the model student or the organized executive, for example–and let yourself be who you are.
12. Remember that what you have is a neuropsychiatric condition. It is genetically transmitted. It is caused by biology, by how your brain is wired. It is NOT a disease of the will, nor a moral failing. It is NOT caused by a weakness in character, nor by a failure to mature. It’s cure is not to be found in the power of the will, nor in punishment, nor in sacrifice, nor in pain. ALWAYS REMEMBER THIS. Try as they might, many people with ADHD have great trouble accepting the syndrome as being rooted in biology rather than weakness of character.
13. Try to help others with ADHD. You’ll learn a lot about the condition in the process, as well as feel good to boot.
Performance Management
14. External structure. Structure is the hallmark of the non-pharmacological treatment of the ADHD child. It can be equally useful with adults. Tedious to set up, once in place structure works like the walls of the bobsled slide, keeping the speedball sled from careening off the track.
15. Make frequent use of:
◦ lists
◦ color-coding
◦ reminders
◦ notes to self
◦ rituals
◦ files
16. Color coding. Mentioned above, color-coding deserves emphasis. Many people with ADHD are visually oriented. Take advantage of this by making things memorable with color: files, memoranda, texts, schedules, etc. Virtually anything in the black and white of type can be made more memorable, arresting, and therefore attention-getting with color.
17. Use pizzazz. In keeping with #15, try to make your environment as peppy as you want it to be without letting it boil over.
18. Set up your environment to reward rather than deflate. To understand what a deflating environment is, all most adult ADHD’ers need do is think back to school. Now that you have the freedom of adulthood, try to set things up so that you will not constantly be reminded of your limitations.
19. Acknowledge and anticipate the inevitable collapse of X% of projects undertaken, relationships entered into, obligations incurred.
20. Embrace challenges. ADHD people thrive with many challenges. As long as you know they won’t all pan out, as long as you don’t get too perfectionistic and fussy, you’ll get a lot done and stay out of trouble.
21. Make deadlines.
22. Break down large tasks into small ones. Attach deadlines to the small parts. Then, like magic, the large task will get done. This is one of the simplest and most powerful of all structuring devices. Often a large task will feel overwhelming to the person with ADHD. The mere thought of trying to perform the task makes one turn away. On the other hand, if the large task is broken down into small parts, each component may feel quite manageable.
23. Prioritize. Avoid procrastination. When things get busy, the adult ADHD person loses perspective: paying an unpaid parking ticket can feel as pressing as putting out the fire that just got started in the wastebasket. Prioritize. Take a deep breath. Put first things first. Procrastination is one of the hallmarks of adult ADHD. You have to really discipline yourself to watch out for it and avoid it.
24. Accept fear of things going well. Accept edginess when things are too easy, when there’s no conflict. Don’t gum things up just to make them more stimulating.
25. Notice how and where you work best: in a noisy room, on the train, wrapped in three blankets, listening to music, whatever. Children and adults with ADHD can do their best under rather odd conditions. Let yourself work under whatever conditions are best for you.
26. Know that it is O.K. to do two things at once: carry on a conversation and knit, or take a shower and do your best thinking, or jog and plan a business meeting. Often people with ADHD need to be doing several things at once in order to get anything done at all.
27. Do what you’re good at. Again, if it seems easy, that is O.K. There is no rule that says you can only do what you’re bad at.
28. Leave time between engagements to gather your thoughts. Transitions are difficult for ADHD’ers, and mini-breaks can help ease the transition.
29. Keep a notepad in your car, by your bed, and in your pocketbook or jacket. You never know when a good idea will hit you, or you’ll want to remember something else.
30. Read with a pen in hand, not only for marginal notes or underlining, but for the inevitable cascade of “other” thoughts that will occur to you.
Mood Management
31. Have structured “blow-out” time. Set aside some time in every week for just letting go. Whatever you like to do–blasting yourself with loud music, taking a trip to the race track, having a feast–pick some kind of activity from time to time where you can let loose in a safe way.
32. Recharge your batteries. Related to #30, most adults with ADHD need, on a daily basis, some time to waste without feeling guilty about it. One guilt-free way to conceptualize it is to call it time to recharge your batteries. Take a nap, watch T.V., meditate. Something calm, restful, at ease.
33. Choose “good”, helpful addictions such as exercise. Many adults with ADHD have an addictive or compulsive personality such that they are always hooked on something. Try to make this something positive.
34. Understand mood changes and ways to manage these. Know that your moods will change willy-nilly, independent of what’s going on in the external world. Don’t waste your time ferreting out the reason why or looking for someone to blame. Focus rather on learning to tolerate a bad mood, knowing that it will pass, and learning strategies to make it pass sooner. Changing sets, i.e., getting involved with some new activity (preferably interactive) such as a conversation with a friend or a tennis game or reading a book will often help.
35. Related to #34, recognize the following cycle which is very common among adults with ADHD: Something “startles” your psychological system, a change or transition, a disappointment or even a success. The precipitant may be quite trivial. This “startle” is followed by a mini-panic with a sudden loss of perspective, the world being set topsy-turvy. You try to deal with this panic by falling into a mode of obsessing and ruminating over one or another aspect of the situation. This can last for hours, days, even months.
36. Plan scenarios to deal with the inevitable blahs. Have a list of friends to call. Have a few videos that always engross you and get your mind off things. Have ready access to exercise. Have a punching bag or pillow handy if there’s extra angry energy. Rehearse a few pep talks you can give yourself, like, “You’ve been here before. These are the ADHD blues. They will soon pass. You are O.K.”
37. Expect depression after success. People with ADHD commonly complain of feeling depressed, paradoxically, after a big success. This is because the high stimulus of the chase or the challenge or the preparation is over. The deed is done. Win or lose, the adult with ADHD misses the conflict, the high stimulus, and feels depressed.
38. Learn symbols, slogans, sayings as shorthand ways of labelling and quickly putting into perspectives slip-ups, mistakes, or mood swings. When you turn left instead of right and take your family on a 20-minute detour, it is better to be able to say, “There goes my ADHD again,” than to have a 6-hour fight over your unconscious desire to sabotage the whole trip. These are not excuses. You still have to take responsibility for your actions. It is just good to know where your actions are coming from and where they’re not.
39. Use “time-outs” as with children. When you are upset or overstimulated, take a time-out. Go away. Calm down.
40. Learn how to advocate for yourself. Adults with ADHD are so used to being criticized, they are often unnecessarily defensive in putting their own case forward. Learn to get off the defensive.
41. Avoid premature closure of a project, a conflict, a deal, or a conversation. Don’t “cut to the chase” too soon, even though you’re itching to.
42. Try to let the successful moment last and be remembered, become sustaining over time. You’ll have to consciously and deliberately train yourself to do this because you’ll just as soon forget.
43. Remember that ADHD usually includes a tendency to overfocus or hyperfocus at times. This hyperfocusing can be used constructively or destructively. Be aware of its destructive use: a tendency to obsess or ruminate over some imagined problem without being able to let it go.
44. Exercise vigorously and regularly. You should schedule this into your life and stick with it. Exercise is positively one of the best treatments for ADHD. It helps work off excess energy and aggression in a positive way, it allows for noise-reduction within the mind, it stimulates the hormonal and neurochemical system in a most therapeutic way, and it soothes and calms the body. When you add all that to the well-known health benefits of exercise, you can see how important exercise is. Make it something fun so you can stick with it over the long haul, i.e., the rest of your life.
45. Make a good choice in a significant other. Obviously this is good advice for anyone. But it is striking how the adult with ADHD can thrive or flounder depending on the choice of mate.
46. Learn to joke with yourself and others about your various symptoms, from forgetfulness, to getting lost all the time, to being tactless or impulsive, whatever. If you can be relaxed about it all to have a sense of humor, others will forgive you much more.
47. Schedule activities with friends. Adhere to these schedules faithfully. It is crucial for you to keep connected to other people.
48. Find and join groups where you are liked, appreciated, understood, enjoyed. Conversely, don’t stay too long where you aren’t understood or appreciated.
49. Pay compliments. Notice other people. In general, get social training, as from your coach.
50. Set social deadlines.
By listening and then repeating back in your own words the essence and feeling of what you have just heard, from the speaker’s point of view, you allow the speaker to feel the satisfaction of being understood, (a major human need). Listening responsively is always worthwhile as a way of letting people know that you care about them. Our conversation partners do not automatically know how well we have understood them, and they may not be very good at asking for confirmation. When a conversation is tense or difficult it is even more important to listen first and 
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