Self care, EllisTangents

Sometimes, Precision Matters

June 10, 2022May 27, 2022 EllisLeave a comment

Sometimes, Precision Matters

There are some language specifics that we’re pretty attentive to in therapy, like “always” and “never” – we catch those pretty regularly. But sometimes, there’s a big difference inside a small difference in language, and therapy is a place where we should really be mindful of some of those, too:

An “excuse” and an “explanation” are the same thing, except that an excuse says “and that makes it ok” at the end.
“Can’t” implies that you are unable (dismisses all internal locus of control). “Won’t” implies that you are unwilling (dismisses all external locus of control). “Don’t” implies neither and leaves the topic open for lots of curiosity. “Haven’t” is similar to don’t, but with even more future optimism.
“Feel” and “Feel like” – unless an analogy is coming next (e,g., I feel the first bird awake on a spring morning, I feel like a bull in pen that’s too small), “feel like” is pretty much always follow by a thought, not a feeling!
The difference between “escape” and “self care” is whether you’re avoiding stressors or doing proactive coping.
When talking about the past, I “should have” (as in I should have known, I should have acted differently) is usually more accurately stated as “I wish I had”

Comment below: What other small language changes have made a big difference in your practice?

Keys to Wellbeing from an Accountant

December 17, 2021November 15, 2021 EllisLeave a comment

Keys to Wellbeing from… an Accountant?

I was reading an article about managing personal finance. And, as often happens, it just kept ringing in the resonance of therapy instead. Here’s what I learned about self care from an accountant:

Live on less than you make
This is message so many of us need to hear. We are so over-extended that sometimes even self-care seems like one more thing on our plates or something we can’t even cram into our schedules. You only make so much money per month, and there are only so many hours in a day. It’s ok to scale back, so that you are living in a way that is sustainable in terms of your time, energy, relationships, and mental health. Don’t worry – having a meaningful, satisfying life isn’t measured in quantity.

Pay yourself first
This is related to the first one, and it’s meant to be a way to help people make sure they have savings at the end of the day – have it taken straight out of your paycheck so you never see it at all! This is a hard one to do with self care, though. Maybe it looks like scheduling all of your physician and dental appointments a year in advance. Maybe it means setting all the house lights on a timer so that it gets dark in the house by 9p? What about prioritizing your self care before you get into a serious relationship, or working that out with your partner before you have kids, so that the expectation is already there? It’s not that you can’t draw on those savings if you need to, it’s just that it’s easier to save when you don’t have to choose to do it every day.

Build your credit if you can
If you manage to “live on less than you make,” maybe you can even go one better… what does building credit in terms of energy, time, or relationships look like? It looks like paying IN to valuable experiences, as long as you can afford to. Once your self care is in hand well enough that you have extra energy, what can you invest that energy in that will pay you back ultimately? And here’s an interesting piece of this – when you ask others for help or favors (going into “debt” with them), that can actually solidify a bond as long as the debt doesn’t get out of control and you’re in a position to be able to extend them a loan, as well.

Don’t rely on willpower
When it comes to saving rather than spending, willpower is NOT our friend. Some people can manage ok, but most of us don’t make great decisions when something pretty or fun is in front of us. And when we’re struggling, it’s even more important. Put that credit card in the freezer and take cash to the store. Start taking care of your own pool if that poolboy is a yummy distraction to your marriage. Block that friend who always needs a loan who pulls your heartstrings. Move your phone to the bathroom if you can’t stop reading the internet when you should be asleep. Set your grocery app to order only the foods you feel great about eating, then fork over the $5 to keep yourself away from the candy aisle. Use willpower only when you don’t need it, to take small steps that make willpower unnecessary.

Good investing means NOT listening to your heart
Emotional investing almost always means poor investing. People get afraid and sell when they shouldn’t; they get excited and buy something that turns out be nothing. When it comes to long-term decisions, even if you’re a feeling-type person, gather as much data as you can. Ask experts. Be conservative. And lead with the prefrontal cortex.

Never finance a depreciating asset
“Buy now, pay later” is the always devil talking. And how do we do that with our time and energy? Don’t say yes to something unless you can reasonably predict that it will be worth more to you in twelve months than it is now.

Never gamble what you aren’t happy to lose
Actually, this tip is usually worded: “Don’t gamble what you can’t afford to lose.” But in a monetary and an emotional/relational way, I prefer the stronger position. IF you’re going to gamble… make sure it’s truly a game. Can you afford to lose your job? Maybe you can. But don’t take the gamble on dating your coworker or telling off your boss unless you’re *happy* to lose your job. Can you afford to lose your marriage? Maybe you can. But don’t gamble on that flirtation or call your partner something you can’t take back unless you’re *happy* to lose your marriage.

Comment below: What do you think? Any others come to mind for you?

Sleep Lesson from my 8 Year Old

September 24, 2021September 23, 2021 EllisLeave a comment

Sleep Lesson from my 8 Year Old

I have to share this amazing sleep tip from my kid!

(Side note: Let me say we do prioritize sleep in the household, but we don’t follow every perfect sleep hygiene prescription because, well, we’re human people. But we do have a nighttime routine and a regular waketime even on weekends! I have a sleep hygiene handout for clients that I really like and you’re welcome to use it if you like – find it here.)

Back to my kids: here is what she told me, completely unprompted:

“Can I tell you how I put myself to sleep? (Yes, of course!) First, I lay down comfortably. Then I yawn. If I don’t feel like yawning, I do it anyway and then it becomes a real yawn. Then I close my eyes. Then I find the place in my body that feels the warmest and I think about it until the warmth goes to the rest of my body and then it’s relaxed and then I’m asleep.”

What an awesome technique!! I told her I would share it with the therapy world and also with clients who might be helped by it. So, there you go.

Comment below: Any favorite sleep strategies that you use or teach to clients?

Avoidance Sucks

August 6, 2021July 16, 2021 EllisLeave a comment

Avoidance Sucks

Here’s what I mean by that:

Avoidance of feared stimuli increases rather than decreases fear. So it perpetuates itself at your expense. This is approximately 35% of all therapy, possibly.
Avoidance is painful by itself. Every time you avoid, you’re having a measure of the pain you would have in confronting. But you avoid it over and over and over… so you have a partial measure of pain over and over and over, which almost always ends up being more painful over time.
Avoidance narrows your options. I mean this in small ways, but also in the very big, existential way – like the “untimely deadness of a too narrow existence”

Some caveats, in case you’re thinking any of these things:

Staying away from genuinely toxic or dangerous things/people/situations isn’t avoidance, it’s wisdom.
If you believe you benefit from a “change of scenery,” you need to give a good think about if it’s escaping/avoidance or something else. A lot of that is how you use that time. If you just get away from stressors and enjoy that, it’s avoidance. If you use the time away to actively work on stuff that will improve your life when you’re back, ok.

Comment below: How have clients sometimes gotten in trouble by avoiding? How have you??

Preposterous Quote – Courage

June 11, 2021May 11, 2021 EllisLeave a comment

There are two levels on which I want to address this preposterous quote.

(1) I dislike, in general, inaccurate measurements. Specifically, in therapy, I dislike the idea that our own limits are not knowable. I believe that’s part of what is fundamentally useful about therapy – building accurate self knowledge and self awareness!

Look, I don’t want clients to live in a constant state of not-fulfilling-their-potential because they underestimate themselves. I don’t want them to reduce themselves to chronic-victimhood because they aren’t encouraged. I don’t want them to choose avoidance as a proxy for safety, when they could choose skills and strength instead. I don’t want them to suffer from the “untimely deadness of a too narrow existence” (Gendlin, 1973).

I also don’t want clients to be shamed or feel shame because they actually do have limits. I want us all to know and honor the limits of our bodies, our strength, our coping. That’s when we know to access additional resources! That’s how we keep ourselves functioning for tomorrow’s challenges!

When you’re drowning, yes…. you do usually have more oxygen available than you’re afraid you have. And use it all, please! You do usually have another half hour in you to work on that project that’s due, even though you’re really tired. You probably do have a little more self control left over to speak kindly to your partner even though you’re stressed out from your work day. You probably do have more strength than you are afraid you have, more than you initially believe you’re capable of.

Let’s learn our REAL limits, so we can grow at our true edges.

(2) I don’t mind the definitions of courage than rely on fear (“It’s not brave if you’re not scared”), but I really prefer the deeply existential understanding of courage – that you willingly act without knowing the outcome. And we never really know the outcome! We pretend we know the outcome, we relax into that lie sometimes, but we don’t ever really know how anything is going to turn out – our action or our inaction. That makes pretty much everything you do “courageous,” if you’re doing it willingly and acting in “good faith” (i.e., with knowledge of your own personal responsibility in living).

Comment below: As always… your thoughts? Your definition of courage?

Not About Pedicures

October 30, 2020June 12, 2020 Ellis1 Comment

It’s Not About Pedicures

I’m quite alarmed by the way that we treat self care, both for ourselves as mental health professionals, but also for our clients. We think about self care the way we think about hunger or sleep – we let ourselves get way overstressed and then we thinking that dropping off the plane in a withdrawal state or going on a self-indulgent binge is the way to somehow repair this.

(Without dismissing the importance of the basic physical health aspects – hydration, good nutrition, regular exercise, adequate sleep…) I’d like to propose a way of thinking about self care that is largely grounded in Csikszentmihalyi’s concept of Flow. The short explanation of Flow, if you’re not familiar with it, is that “zone” we get into when we’re involved in an activity that is just the right balance of challenge with our skills. It’s a balance, because if we’re engaged in things that are too easy, we get bored. If we’re engaged in things that are too difficult, we get stressed/anxious. If you’ve been in that zone, you know what I mean. In that zone, you don’t really run out of energy – the energy just seems to self-replenish.

I believe in our clinical work, we often get ourselves (or find ourselves) out of balance.

We take on too much – too many clients, too long of days, clients who are legitimately outside our boundaries of competence but we don’t want to admit it, expecting to have the same therapy-stamina as the most productive person in the office.

Or we take on too little – get into a therapeutic rut and don’t challenge ourselves to build new skills, we are in an overly systematized job and function as automatons rather than clinicians.

Sometimes, it’s that we feel we have no control – we’ve given up our autonomy to a harsh internship director for the sake of getting hours (oh, how you’ll regret this!), we’re so burdened by rules and paperwork that our actual clinical work is only a handful of minutes per hour or day.

And sometimes, it’s that we know the work isn’t meaningful – we can see that clients aren’t improving, our setting won’t allow for the care clients need, etc.

Real talk: if you are exhausted at the end of a perfect clinical day – engaging, moderately challenging clients with a diversity of experiences and concerns who you can have some degree of independence in working with – this might not be your calling. But I’d say that’s probably not most of us. And once you become aware of the ways your clinical work is pulling you out of Flow, you can begin to correct it!

Comment, please: Which way do you find yourself leaning out of Flow? How can you see this also working in clients’ lives?

Before burnout begins

May 22, 2020June 23, 2021 EllisLeave a comment

Before burnout begins…

How do I know when my client load is getting too high?

First, let’s define “client load.” Number of clients is part of it, certainly. Number of clients divided by number of available sessions and days at work is also a part of it. (Having 16 clients in 16 session spots over two days is way different than having 16 clients in 35 session spots over 5 days!) But clients aren’t all created equal. So, a lot has to do with combinations of clients, your own feelings of effectiveness and meaningful work, diagnoses and personality types you work with best, if you’re one of those clinicians who gets energy from couples/families vs. finds them to be energy vampires. So, how many clients we have often has very little to do with if our client load is too high.

I think we’ve been trained to notice when it’s already too late. You know the signs of burnout, right? You have trouble getting out of bed for work, you’re “phoning it in” with clients, you can tell you should care but you don’t, you are isolating from colleagues, you’re catastrophically behind in your documentation and yet not making headway, you’re emotionally numb or nonreactive.

And before burnout comes overstress. That’s when you wake up anxious before work, “bring clients home” with you mentally, begin dropping behind on documentation and feel pressured to catch up, having trouble shutting your mind off, are cranky or a bit emotionally reactive even at home.

It’s also quite good to notice this before you really get all the way to overstress and/or burnout, because if it gets that far, and you need to reduce your load, that can be another additional stressor.

I’d like to share a few ways I notice when I’m reaching my effective client load limit.

I’m not learning something new for a client
- There’s never a time when I have a case load that is so low or clients who I know so well or I’m so “knowledgeable and competent” that I don’t have something to be learning outside of session. Sometimes, that’s psychotherapy theory or skills related; sometimes, it’s learning about something that’s relevant in a client’s world (e.g., the path to professional soccer, the pokemon universe, and Japanese cultural mores around drug use have been things I’ve learned about recently). If I don’t have the mental space and time outside of session to be learning something for a client, it’s a sign to me that I’m needing to use all of my non-client time for family and self-care. That means the next thing that will slip will be client care!
I’m bored or distracted in session (with a client I’m not usually bored or distracted with)
- Some clients are boring, and that’s good clinical information. Some clients are distractible, because it’s part of their diagnosis. And I get distracted in a way that’s normal for me, that’s session related. But when I get bored with a not-boring client, or distracted (especially by thinking about other clients during one client’s session), that struggle to “stay present” is an early sign to me that client load, in the mental capacity way, is getting too high.
It’s takes more than 20 minutes at the end of the day to finish notes
- For me, I almost never take notes in session after the intake. Also, I’m quite bad at letting clients out at the :50. So, I usually end up with about 3-6 minutes to write notes, read last week’s notes on my next client, and maybe do one other thing (this is either run to the restroom, refill my coffee, or do a super quick meditation or centering exercise). My notes include two main parts – a summary of the important session material (so I can read it next time before session), and “the boring stuff” – client name, date, session #, MSE check boxes, treatment plan updates, etc. So, I write the summary in my 3 minutes along with the client’s name right after session and then I leave the “boring stuff” for the end of the day. It’s no problem to finish the final note and 6 “boring stuffs” in 20 minutes. If I’m not able to, it’s because I mismanaged myself during the day, and that’s usually because my client load is too high. I’m keeping clients extra long and then running behind, I’m not taking time for centering, or I’ve struggled to summarize.

Noticing is one thing. Committing to doing something about it is another. Ask your favorite colleague, your best non-work friend, and the person you share a budget with (if you have one) to all help you commit to delivering excellent care by acting when you’ve noticed you’re approaching your limit, not past it!

Comment below with the ways you notice you’re approaching your limit!