Not sure about therapy?

I’m a therapist so obviously I’m a pro-therapy individual. I drink the therapy kool-aid so to speak.

But I get it. You may not be into the same kool-aid that I am. Maybe you’ve considered doing therapy, but you’re just not quite ready to commit.

Maybe it’s not the right time. You’re trying to keep to some sort of teleworking schedule. You’re trying to be a homeschool teacher. You’re trying to KEEP. IT. TOGETHER. I get that. Therapy is a time a commitment. You’d need the hour+ (ask me about intensive therapy options!) in addition to some headspace to practice the therapy skills in your real life.

Or maybe you don’t have the finances for it. You or your spouse has lost their job. Or you’re job is still intact but the clients have gone down, meaning your income has gone down. I get that too. I do offer some discounts, (see COVID discounts) but therapy is still an investment and you would need to decide whether you’re ready for it.

Or maybe you don’t know if you really need it. Maybe you question whether things are that bad? You compare yourself to other people and see that their life circumstances seem way worse, so who are you to complain? I get that, too. There will always be a reason to not start therapy, and very many people wait until their absolute breaking point before scheduling an appointment. Then again, there’s also the chance that what you’re going through will get better on it’s own, and you can handle it without going to therapy.

So, for those of you who are considering therapy – but aren’t ready to jump in just yet, I give you a list of exercises you can try on your own to start the process. And – bonus – should you decide to start therapy, some of your work is already start.

1. Start monitoring. 

There’s a quote by business strategist Peter Drucker that says “what gets measured, gets managed.” If you’re currently dealing with a low mood,a dn you’re hoping to change that, one of the first things you can do is to start measuring it. What do I mean? I mean just jotting down on a 1-10 scale where you mood is on a daily basis. You can be more specific by rating your depression, anxiety, stress, anger, etc separately, or do your mood as one big lumped feeling. If you struggle with relationship challenges, rate that. Question whether you have disordered eating? Rate your urges to use those behaviors and whether you use them. Is there a pattern to your mood? Are certain environments, situations, or people tied to your lower/higher mood days?

2. Describe your day

In Cognitive Behavioral Therapy (CBT), one technique is to describe how you spend your time on a given day. Starting with when you wake up, write out your daily schedule and then rate each activity based on how much enjoyment it gives you, how important it is and how accomplished it makes you feel.  

TimeActivityEnjoyImportantAccomplished
7-8amBreakfast w/kids263
8-12pmHomeschooling174
12-3pmWork Meetings475
3-6pmHelp kids w/school work255
6-7pmDinner453
7-8pmBedtime for kids273
8-10pmWork287
10-12amNetflix500
Example Activity Chart

When creating your daily activities list, it can be helpful to give perspective to your rating scale. What is your maximum, minimum and middle for each rating scale? Ie, for me, dancing to 80s music is a 10, grabbing a coffee with a friend is about a 5, and managing my toddler’s tantrum is a 0. Sometimes we may describe an activity as awful, but when compared to something we really don’t like, it’s not that bad. I don’t like filing taxes, but I would happily work on my taxes over dealing with a toddler tantrum.

3. Identify mini-goals

Much of therapy involves goal setting. “What do you want to get out of counseling?”, “How do you want life to be different?”, or “If you could wake up tomorrow and the problem you’ve mentioned has resolved, what would your life look like?”, etc. Because of these big-picture questions, client identify big-picture goals: “I want to feel good again”. “I don’t want to hate myself anymore”. “I wouldn’t be stressing over every little thing”.

And these are great starting points to give the therapy some direction. A therapist would then help you break those down into small, more concrete goals, so if nothing else, you’d know when you reached them.

Fortunately, you don’t need a therapist to set goals. But, as a suggestion, the smaller and more objective you make your goals, the easier it is to identify correlating action steps, so that you can, you know – actually achieve them. So for example, maybe you’re very much aware that you’re not getting enough sleep and you would like to get more. How much more sleep would you like to get? What time would that mean you need to get in bed by? What historically has prevented you from adhering to some sort of bed-time routine? What would be all the little steps you would need to take in order to increase your sleep quantity/quality? Now, pick one of those steps to start with, and try it out this week. Life is not a sprint. It’s not even a race. It’s a journey and every step you take, regardless of how small, is still forward movement. What movement can YOU take tomorrow, or even right now, towards your goals. 

4. Read your goal list daily

How many times have you decided you were going to either start a new habit or stop an old one? You start off gung-ho and super motivated: This is going to change your life! You’ll be so awesome after this! And within a few days, you’re cutting corners, forgetting what you set out to do, or, gasp – blatantly refusing to follow you’re own guidance. We’ve all been there. Establishing habits to reach our goals is hard work. What makes it slightly easier is having ever-present reminders that we want this change, AND then making ourselves acknowledge those ever-present reminders by rereading our goals. If you have a post-it note with your “drink more water” goal stuck to your coffee pot, to your computer monitor, to your steering wheel, etc. You’re more likely to 1) remember you made the goal in the first place and 2) take action to work towards that goal. Of course, if you’re at all like me, this won’t do anything for those rebellious streaks that see such reminders and shouts “Screw you! I don’t want to drink water right now! Now give me my coffee!”

5. Increase your exposure to positive messages

Look, our brains are already really good at identifying all the crap in our worlds. The news and social media echo apocalyptic visions of our socially-isolated futures, resulting in a situation in which there’s basically no way to avoid the negative spew unless you’re trying really hard. If you’re already feeling emotionally on-edge, you may be one comment away from camel back-snapping territory (as in, the back of a camel snapping under burdensome weight of life – not a broken camelbak (R)). You may not be able to control all messages you’re brain receives, but you do have some ability to combat the negative that you’re receiving. This could mean:

  • Limiting your exposure to people who are excessively pessimistic
  • Following people on social media who offer uplifting messages
  • Balancing your news consumption with some positive stories
  • Spending more time talking with friends and family who encourage and support you
  • Leaving yourself affirmations around your house/workplace (“This sucks, but you can do it”, “you’re freaking awesome at your job”, “this too, will pass”, etc.)
  • Offering those around you words of support and encouragement. We could all use a boost.

Doing the exercises above won’t replace the feedback and guidance you would get from a licensed mental health professional, but they will give you an idea of where you could use additional help. If you find these exercises challenging, or maybe life is too overwhelming right now to even attempt them, I would encourage you to reach out for help. If you’re at all curious, remember that I (and most other therapists) offer free consultations. That means you can test the waters with no commitment required.

If you’re considering therapy, what is holding you back from saying yes?

Why following through is hard

This week my daughter is out of school on yet another break. I swear she has a full week off of school every other month. Thankfully we’re abroad with this type of schedule because attempting to find childcare or vacation days to cover all of those days would be a nightmare in a place like the US.

Kampala unfortunately does not offer extensive activities for kids to do, so I decided that we would be explorers and set out on a mommy-daughter adventure. We packed our bathing suits and some snacks, downloaded the Frozen 2 soundtrack, booked ourselves in to the ViaVia guesthouse in Entebbe and set off into the great unknown.

This was my vision: We’d arrive at some enchanted forrest, skip through fields of exotic flora and fauna, oo and ah over different bird chirps, chase butterflies, splash through puddles trying to catch lizards, dip ourselves into the pool when the sun got to warm, and obviously end the day with a campfire and some hot cocoa while listening to grasshoppers chirping. Maybe I’d even let her stay up late to look for shooting stars. It was going to be magical.

The reality of this trip, alas, did not quite match the description above. While I do give myself gold stars for doing the trip in the first place AND saying yes to my kiddo more than I said no, I still found myself at my breaking point on more than one occasion.

Like many parents before me, I found myself snapping with an “DO YOU WANT TO GO HOME RIGHT NOW?! WE’LL LEAVE RIGHT NOW IF YOU CAN’T DO WHAT I ASK!!”

Cue face palm and a disappointed sigh. Even when you KNOW what to do, doing the thing doesn’t always come easy.

In my defense, after every snap (in therapy terms – a rupture), we did repair within a few minutes, so on the whole we both had a positive experience. But it happened enough that even my daughter (who is a wizened 5 year old) told me “Mommy, you don’t have to yell. You just need to calm down first and then talk to me”. #kidsoftherapists

A few days ago I wrote about the importance of breath work in battling stress, anxiety, anger and general emotional distress. I am completely and 100% fully on board with using breath as a tool to calm my nervous system. I know the science behind it. I’ve personally experienced improvement in my mood when I do it. It doesn’t even take a long time to incorporate.

And yet, when in the midst of a stress tornado, I let the emotions consume me and I turn into a snarling, grouch monster.

Come on. Do Better.

That’s what I hear in my head after the anger wave has receded. Not only do I allow my emotions to take over, but then my inner critic gets in on the action and throws a few quick jabs. It’s incredibly frustrating, on both fronts.

So what can be done?

In the short term:

  1. Wait til the dust has settled. Sometimes we get hijacked by our emotions and we don’t always feel fully in control. At the first inkling that your hands might be back on the wheel, start taking corrective action.
  2. Breathe breathe breathe. The emotion has likely peaked by this point, so now work on getting yourself back to homeo stasis. Release whatever tensions has been stored up in your muscles.
  3. Scan your thoughts. See if you can reroute any lingering negativity. Now is a great time to practice some CBT thought exercises. Is my daughter REALLY a little demon sent to annoy me? Do I have any evidence that she is doing this on purpose? Or is she just being a 5 year old who has different ideas of what appropriate behavior is? And even if she is intentionally acting like a turd, is it really worth exploding at her? Are there other options for how to react?
  4. Survey the damage/Fix what can be fixed. Take responsibility for your actions. You may be entirely justified in the emotions you’re experiencing, but sometimes actions aren’t always necessary nor are they most conducive to getting what we want. Apologize as needed. I find myself apologizing often to my kiddo and then use the opportunity to explain what was frustrating me about her behavior. She’s usually more receptive to these conversations than if I were to just yell at her and give her the “because I said so” line.

In the long term:

  1. Remind yourself that this is the work. I was listening to a Tim Ferris podcast a couple of years ago of an interview with meditation expert/Buddhist monk Jack Kornfield. Kornfield commented on how the day-to-day living can be just as transformative as doing a 10-day meditation/yoga retreat in some isolate enclave. Kids, family, customer service reps, whomever, can all serve the role of a Zen master teacher, offering you opportunity after opportunity to reflect on how you’re living life.

But what makes it work is that you have that intention, not just to soldier through it, but to say let this be a place where I awaken graciousness, an inner sense of freedom and peace as things come and go, where I awaken the possibility of presence, and pleasure, and pain, and joy, and sorrow, and gain, and loss, and all the changes that I find inviolable, or a timeless place of becoming the loving witness of it all, becoming the loving awareness that says, yeah, now I’m having a family experience. And this is the place to find freedom. Because freedom is not in the Himalayas or in the Amazon. The only place it’s found is in your own heart, exactly where you are.

Jack Kornfield

2. Explore your internal. Behavioral reactions never come out of thin air, regardless of how it may seem. They’re more like the end domino in a long chain of reactions. What was happening internally before your tantrum that may have contributed to your outburst. Were you tired? Hungry? Already feeling stressed out from a morning commute? Did you have negative thoughts about yourself, someone else or the environment bouncing around in your head just prior?

3. Keep practicing. It’s like when you’re learning meditation. Your thoughts wander off and the goal is not to prevent them from wandering off, but just to notice that they’ve gone astray and gently refocus them. When you’re emotions get the best of you, notice what happened that pushed your buttons and gently refocus yourself and nudge yourself back into alignment.

We all have those moments where we act like assholes, but luckily, we aren’t graded on those single moments or single interactions. Instead, we can use these moments to reflect and grow towards a better version of ourselves.

What was a situation in which, despite your best intentions, you let your emotions get away from you? How did you respond?

Why Everyone Tells You to ‘Just Breathe’: And why you should listen

Picture this: you’re getting ready for an international flight. Maybe you’re finally flying home to see family or maybe there’s an important work conference you’ve been tagged to attend. You’re not the best flyer, so you’re already feeling a little anxious about the whole thing. You’ve attempted to prepare as best you can, packing the night before and ensuring that all your essential documents are readily accessible. You call a cab to bring you to the airport, allocating plenty of time to get there, check-in, get through security and even hit the bathroom and grab a snack before needing to board.

The cab miraculously arrives on time and off you go, mentally running through all your check-lists again and again. You feel somewhat relieved in knowing that at this point, you’ve done as much preparation as you can, so now it’s just go-time. That’s when you notice your cab slowing down. You peer out the window to see a field of red brake lights and exhaust pipes. 

What the…?

You pull out your phone. Google maps showed no traffic before you left, but now, to your horror, you watch as it becomes orange, then red. Well shit.

You feel your pulse quicken and your breathing becomes more shallow. Your whole body becomes tense. You suggest to the taxi driver that maybe he could take an alternative route but the car is smackdab in the middle of traffic, and there’s no way he’s moving without all the other cars around him moving first.

Your mind is racing in 1000 different directions. What if we can’t get out of this? What if I miss my flight? What if there aren’t any other flights leaving today? Even if I make the flight, what if my baggage doesn’t? If I can’t get out the next day is my trip ruined? Should I call the airline now and see if I can shift my seat? Should I get out now and try to walk to a different street? Surely it would be faster to walk at this point. Do I cancel the trip? Agh! What do I do?! Why does this always happen to me?!

Want to know what you should do?

It’s fairly straight forward. One of the most common anxiety/stress-relieving suggestions there is.

Ready for it?

Just Breathe.

What? That’s it? That’s Bogus!! That doesn’t fix anything!

You’re right. Breathing doesn’t necessarily fix anything. It won’t magically get rid of traffic and it won’t hold your flight for you. But it will do something I consider fairly magical.

Breathing gives YOU control over which part of your nervous system you want activated. Are you about to face down a lion and need to summon all your body’s resources? Great, then start huffing and puffing. The sympathetic nervous system (aka, fight/flight) is up and running and will direct all energy towards survival.

No lion? Then it’s time to manually take over and get your nervous system to cool its jets. 

Start by focusing on taking long, slow exhales.

Exhaling in general is associated with a slight drop in heart rate, and it brings your parasympathetic nervous system online. Not only will this make you feel calmer and more relaxed, but in this state your brain is taken out of problem-focused tunnel-vision mode and is able to operate more holistically. You can see opportunities instead of just limitations. You’re better able to accept whatever life throws at you, even if that means a missed flight.

Perhaps you see breath work as a bunch of woowoo fluff, and if so, I don’t begrudge you one bit. But the science is there. And for me, there is something validating in knowing that I have some control over how my body is reacting.

Try this at home (or anywhere): Start by breathing normally, whatever that may be for you. Count out your inhale, then attempt to make your exhale a little bit longer. With each breath cycle, try to slow yourself down a little bit more, even pausing at the top and bottom of each breath. 

After doing this for a couple of minutes, what changes do you notice in your body?

Where to Begin When You’re At a Loss

“I don’t know what to do anymore”

“I’m desperate to stop this”.

“I’m miserable. I can’t stand this.”

“I can’t handle this anymore. It’s getting worse. I’m getting worse.”

“I don’t want to be like this anymore. But what can I do?”

“I hate this. I hate myself. I’m never going to get better.”

As a therapist, I typically interact with people when they’re in a low place. Unsurprisingly, folks don’t typically seek out therapy when things are going great and just want a mental health check-up (though I do wish this was more often the case). Instead, I’m usually a last resort. Something in life is not going well and despite your efforts to ignore or change things, you’re still just stuck.

That helpless and hopeless feeling is one that I am intimately familiar with, both from witnessing it in the life of my clients and experiencing it in my own personal life. You feel as if you’ve tried everything. Nothing has worked. If you don’t do anything, you’ll be stuck this way forever. But imagining having to live this way for any longer is enough to drive you into panic. You don’t WANT to live this way forever.

But what are you supposed to do?

This is one of the most common scenarios I see in my office. Life has become awful. Change needs to happen. But the how is often a big grey fuzzy space. My clients come to me hoping that I can show them the how.

But therein lies the trap.

The most common mistake I see in people attempting to address their own issues is that they focus on the wrong questions.

For example, someone who is struggling with binge-eating will ask themselves repeatedly – “How can I stop bingeing?” or “What am I doing wrong?” The brain, handy little organ that it is, perks up and starts searching for answers: You could fast. You could cut out all sugar/carbs. You could drink water when you feel the urge. You could binge on carrots instead of cookies. You could distract yourself. You could go for a walk. You could clean out your kitchen of binge foods. You could just use sheer willpower. Just say NO.

You could do all of these things and more. Maybe you’d find some success. But chances are, the binges will still happen. Why?

Because before you do anything else, you need to understand your WHY

Why do you want to give up bingeing?

The ‘why’ represents your overall motivation for a change, and no intentional change will happen without it.

You may be thinking, “Are you kidding me? Of COURSE I want to change!! I’m miserable right now!” That may be true, and yet, despite the misery you’re in, something has kept you where you are now and prevented you from taking the necessary steps forward. Often times, there is a part of us, sometimes a small part, sometimes a large part, who is resistant to the very idea of change. Things may be miserable right now, but at least they’re familiar, and familiar means comfortable. In motivational interviewing language (a common therapy modality), this would be called a Double Approach/Avoidance conflict. The more you try to change, the more enticing it is to stay the same. But the more you stay the same, the more you realize you need to change.

This does not mean that you’re destined to stay stuck forever. This means that ambivalence towards change, any change, is normal. It also can give you a way forward. Give yourself a chance to explore what you’re really wanting from a change, and maybe also what reluctance you have.

If you, like me, tend towards skepticism, you may scoffing at the idea that any part of you wants to keep things how they are. So I challenge you – the next time you go to use one of these problematic behaviors you wish you could change, what prevents you from doing so?

What in-the-moment reasons do you give yourself for why you can’t change?

Digging into your thoughts: What’s driving your inner dialogue?

Thoughts Upon Thoughts

“She’s more flexible, but I’m doing the pose better”.

I noticed the comparison in the midst of a yoga class (and yes, there is yoga in Uganda). Why am I doing this, I thought. Here I am, trying to be zen and focused on my own journey, and yet my head still automatically targets other people as a way to judge my worthiness.

Thankfully, I’m at a point in my life, where while I still find myself making comparisons to and judgements about others, those comparisons don’t automatically drag me into a downward spiral of self-loathing. Mindfulness teaches us to notice our experience. To notice the thoughts, acknowledge them, but let them go. Observing in this way offers us insight into our brain’s innerworkings.

Using some of my therapy skills, I decided to explore what all of this was about. I could debate my thoughts. Challenge them as not being truthful and pretend I hold the opinion of some entity other than me. But in this case, that doesn’t quite work for me. I mean, the thoughts wasn’t wrong. The woman is more flexible than I am. 

So I follow the thought further. Why does it matter if she’s more flexible? She may be better than me in one way, but I’m better than her in another, more significant way. Okay, but again, why does this matter? Dig further. If I looked at the person next to me in class and saw that she was more flexible AND nailed the posture, what then? It would indicate that I’m less than. I’m not good enough. I won’t ever be good enough. There is something inherently lacking about me.

OOfta. That gets heavy quickly. And yet, there it is. This belief stuffed way down into my core.

There is something inherently lacking about ME.

All day, every day our heads bombard us with thoughts. Sometimes those thoughts are helpful: Don’t forget to go to the store. I need to call my mom today. I wonder if the subway would be faster today. Those apples are more expensive than they were last week. They’re part of the day to day chatter of our brains as they navigate the world. And then, in the midst of those thoughts, other more nefarious characters arise. You WOULD forget to go to the store. Now there’s no toilet paper you dimbulb! I can’t believe you said that to your mom. I wouldn’t be surprised if she didn’t talk to you for a week. Why did you decide to take the subway today?! Now you’re going to be late and probably get fired!

Do you see the running theme in the second batch of thoughts? I do: YOU SUCK! YOU’RE THE WORST! But let’s be honest. Your thoughts can get way harsher than what I just described. They’re straight ruthless. They’ll tear you apart in microseconds because they know just what to say to target your most vulnerable insecurities. And the crazy part? WE BELIEVE THEM!

I’ve had conversations with clients who, without a hint of sarcasm, will say that they are clearly the worst person that has ever lived. At some point in their life they have acquired this message, and not only decided it was true, but decided that it was a belief worth defending. 

Fortunately, beliefs can be changed. Because I’ve been doing my own inner work for awhile, when those little beliefs pop up now, I’m generally able to tell them to screw off.

Which of your beliefs do you wish you could tell to screw off? What do you wish your thoughts would tell you instead?

Welcome Home!

So you’ve made the decision to move away from home. Congratulations! Welcome to adventure, excitement and interesting, new friends from exotic places! 

Orrrr not.

Now reality has hit. And you’re in this new place. And it looks different. And it sounds different. And it definitely smells different. And you don’t know where anything is. You don’t know anyone. And if you have any hopes of actually making a friend in this new place, you’re doomed to sludge through the superficial chit-chat about the weather or where you’re from for the next several weeks (or months, or years) before any real relationships begin.

I’d like to think I adapt to new places fairly well. I usually give myself a time frame – 90 days for example – in which I could expect things to be weird and awkward and lonely. After that timeframe, I knew I would start to feel more settled. I’d know where to go to buy food. I’d have an idea of how to get around. Maybe I’d even have the makings of a few friends. But adapting well doesn’t necessarily make the adaptation process easy or even enjoyable. 

Encountering newness at every turn becomes exhausting. What you used to be able to do on autopilot now requires significant mental and emotional energy. 

I may be on my own in this, but back in the States, I generally love going grocery shopping. I enjoy checking out new ingredients, formulating potential meals in my head, and making sure my pantry and spice cabinet are well-stocked. The first time I went grocery shopping in Uganda? It was almost panic-inducing. Not because the store was particularly chaotic, but because nothing was what I was used to. The store layout didn’t make sense to me. An attendant had to pre-weigh all of my produce prior to check-out. Half the products were labeled in a language other than English or even if it was in English, they’d use different terminology. The milk came in bags (??). Not to mention the mental arithmetic of converting currencies to figure out if you’re being fleeced. 

It certainly makes me less inclined to go grocery shopping.

And yet, this is it. This is home for the next however many years. And that means figuring out the little things (and the big things) and moving on with life. It means making the effort, day by day to learn. It means constantly pushing yourself outside of your comfort zone again and again and again so that with time, and maybe a little luck, your comfort zone expands, and this new places actually starts to feel like not just a home, but your home. 

But what if that doesn’t happen? 

What if instead of feeling exhilarating or adventurous, this new life feels claustrophobic or boring? What if your comfort zone starts to constrict instead of expand? And those daily reminders that you’re in a foreign place begin to squeeze in all around you? You attempt to make the most of things, but those people, places, and behaviors that used to keep you tethered back at home are hard to find here – or worse, nonexistent. You find yourself becoming more insulated. You start resorting to old (or new!) behaviors that you know are not great for you, but become essential if you just want to get through each day. You feel trapped. You feel alone. Now what?

You could:

  1. Call it. Say enough with this whole expat life and return home. There’s no shame in trying something new and deciding that this isn’t for you. But, depending on your family/work/school situation, you may not be able to pull up anchor whenever you see fit. You may be stuck here for awhile, in which case you could:
  1. Just keep swimming. Maybe it will get better on it’s own. Maybe you only have a few years left of this place and you think you can probably survive until it’s time to move. Not the most empowering of scenarios, but it’s a strategy. It could work. But then again, maybe you think in your head that there’s NO WAY you can manage this for X more years. Something has got to change:
  1. Make a change. Something is obviously not working for you. You can choose to attribute your misery to the location, and maybe it plays a huge role in your overall well-being, but there are likely other factors contributing to how you’re feeling. Are you taking care of yourself physically, mentally, emotionally, socially, financially, and spiritually? Which area is being neglected? Maybe one, maybe all. So pick one, let’s do something about it.

What’s one area of your expat life that currently isn’t working for you? How is it contributing to your overall well-being (or lack thereof) and how would you want it to be different?

Need a little extra accountability? Drop me a line with your answer. I personally read every reply and respond back!

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