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Self-Care - for Depression Awareness Week

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Edited by Meg-John Barker, Monday, 11 Apr 2011, 13:15

Self-Care

This week is depression awareness week (11-17 April). The most important thing I have to say in relation to depression is about self-care.

Towards the end of this week I'm going to an event about which asks, among other things, how people can nurture practices of 'self-care'. Towards the end of last year I ran a weekly workshop on self-care practices, and I'm running a day for therapists on the same topic this Autumn. The first chapter of the book I've recently written about relationships focuses on self-care. Here I want to look at why I think self-care is so important, what it is, and how we can build it into our lives (both when we are depressed and when we aren't).

 

Why Self-Care?

There's something wrong with me that needs fixing.

 

The most striking thing, for me, after several years of working as a psychotherapist, has been that virtually every person who comes for counselling or therapy believes that there is something wrong with them which needs fixing. A big part of this is the sense that everyone around them is managing life fine, whilst they are really struggling. There must be some lack or flaw in them in comparison with the rest of the world and they are desperate to put it right. Why can't they just be normal? What is wrong with them? Why aren't they like everyone else?

 

Sound familiar? I was certainly extremely grateful for this experience of person after person expressing sentiments that I had felt myself so many times. I now try to imbue therapy sessions with this sense that what is normal is to feel abnormal and wrong in this kind of way.

 

Reading about this sense of lack I've recognised that much of it is down to the difference between the image we present to others and our own inner experiences. The reason that people feel that there must be something wrong with them is that they are comparing themselves against the perfect, shiny people they see every day at work, on television, in the shopping mall, on facebook. But of course they themselves are likely also presenting a similar image to other people. When someone asks how we are we generally say 'fine' and accentuate the positive. Recent research has found that we write about the good stuff in our lives on social networking sites far more than what we are finding difficult. We know the messy, ugly and frightening stuff of our own selves because we live in them, but our point of comparison is a bunch of people who are unlikely to reveal that similar stuff to us unless we are very close to them indeed, or perhaps their therapist!

 

There may have been an element of this kind of comparison through history, but it is certainly exacerbated at the time we currently live in. Just think about the number of times each day that you receive the explicit or implicit message that there is something wrong with you which needs fixing. Maybe try counting for just one day. The explicit messages are easiest, although we don't often think about them. Every billboard advert and commercial on television, radio, or at the cinema, tells us that we need to be younger, more attractive, more successful and happier by owning more products or have more experiences of the kind that they are offering. This is also an implicit message in many newspaper articles, Hollywood movies, and reality television stories which tell accounts of the achievement of happiness, success or beauty through doing certain things, or sometimes of failure to achieve because of not having done such things as going on a diet, buying a lottery ticket, starting up a business or appearing on a television show. And we are certainly encouraged to compare ourselves to the airbrushed images in magazines, the snapshots of people we get in a brief news story, or to the characters who are being acted out by professional performers. We become used to comparing against a selective version of somebody's life rather the full warts-and-all picture. We could also think more widely about educational systems and organisational processes which are about comparing people against each other and striving for 'excellence' rather than being good enough.

 

Clearly there are important political conversations to have about this socioeconomic situation which underlies a good deal of current human misery. This is something that is frequently ignored by solutions which focus entirely upon the individual, including many forms of therapy, drug treatments, and people suggesting that we 'pull our socks up' (not that these things can't be helpful in their place, but if they obscure the wider context then there is a danger that they reinforce the idea that there is just something wrong with the individual person). In addition to addressing the wider context, what can we do as individuals to protect against this kind of toxicity, to help us to see these process as they operate through us, and to support each other better?

 

One suggestion is self-care.

 

What is Self-care?

It could be argued that, at the same time that society has become so consumer-oriented and focused on individual improvement, we have also lost some of the means we had in the past for caring for ourselves and for reflecting on our lives. It is very easy now to go through days and weeks without ever having a moment of quiet alone. We can easily fill our lives with noise, work and distraction such that we are always playing games on our phone, listing to podcasts, emailing, watching television, meeting people, getting tasks done, or socialising. When we do this it often gets increasingly frightening to be alone with ourselves. We can be anxious about what we will find. If we are struggling this means that it can often reach a crisis point before we do anything about it.

 

I'm not saying that those kinds of activities can't be done in caring ways (see my last blog entry on mindfulness), but I'm arguing that it is useful to ensure that we have some time in our daily lives devoted to being quiet, to looking after ourselves and to tuning in to where we are at. Otherwise it becomes increasingly difficult to tune into our needs (are we getting enough rest, food, support, activity, etc.) and also to tune outwards towards other people and the wider world.

 

Self-care is not just another form of monitoring ourselves and finding ourselves lacking, although we are so used to doing this that we need to watch out for it ('damn I haven't built any self-care into today – bad me!'). Similarly it isn't about just giving up on ourselves and thinking we may as well do comfortable nice stuff because we are no good anyway.

 

People's biggest block to doing self-care is often the idea that it is a selfish or self-absorbed thing to do. My own view is quite the opposite. Constant self-monitoring and self-improvement is self-absorbed because it is so internally focused that it often prevents us from seeing the fullness and struggles of other people. It also exhausts us to the point that we have very little to give to anyone else.

 

Caring for ourselves means that we are more aware of the kind of painful processes going on for us that make us despondent or fearful. This means that we can tune in better to the fact that other people likely have those same processes, so we can be more compassionate with their snappiness, withdrawal or neediness. We are less likely to just feel hurt and betrayed when others treat us poorly, because we understand it better. Also, when we have looked after ourselves we generally have more energy and patience for looking after others and for engaging with the world more broadly. We are more able to open up because we are less fearful of showing the fact we are lacking and imperfect: we know that everybody is.

What kind of self-care, and how to build it in, is up to each person. Different things work for different people at different times. I'd suggest making space for two things: kindness and reflection. Kind self-care is a way of demonstrating to ourselves that we are as deserving of kindness as anyone else (even when we don't quite feel that we are). Reflective self-care is a way of checking in with ourselves, tuning into our body and our emotions, asking ourselves how we are, thinking through any issues we are currently dealing with, making sense of why we are finding something difficult.

 

Examples of kind self-care that work for some people include: having a hot bath, giving yourself a treat, taking half an hour in a cafe, spending time with friends, being in the garden or park, sharing a hug with a friend or pet, and watching your favourite programme. Example of reflective self-care include writing in a journal, having a session with a close friend where you both have time to talk through whatever is on your mind, going for a walk, and meditating.

 

It seems to be really hard to build these into our everyday life. Our tendency is often to leave them till last (if we get everything else done) rather than prioritising them. When things get tough we are often even less likely to do these things because we feel that we don't deserve it, and we are often scared to be quiet or to tune into ourselves because we fear that we really will find something terribly wrong with us. Gently trying to build in a daily kind act towards ourselves is often a good first step at such times, followed later by also taking some time to kindly listen and reflect upon what is going on in our minds and bodies.

 

Given the world that we live in it is likely that we will keep forgetting self-care and needing to remind ourselves, and that we will easily slip into beating ourselves up about it or doing it with the secret hope that it will make us all 'better' or stop us from ever struggling again. When those things happen it is just another reminder of our imperfect humanness, and of the messages that surround us and others that make this so hard.

 

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Mindfulness: It ain't what you do it's the way that you do it

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Edited by Meg-John Barker, Wednesday, 17 Aug 2011, 16:56

 

Mindfulness: It ain't what you do it's the way that you do it

I've been interested in mindfulness for several years now and will be writing a book about it in the next year or so, building on the chapter that I wrote for the OU counselling module.

Mindfulness is the big idea in counselling and psychology at the moment. The 'gold standard' of counselling - cognitive-behavioural therapy - is turning to mindfulness as its 'third wave'. If you go to a mental health services it is likely that they will offer some kind of mindfulness training. Self help books for depression and anxiety are increasingly mindfulness focused.

One conclusion that I have come to is that there is no such thing as an inherently mindful or non-mindful activity. People (including myself at times) often have the idea that only certain activities could be mindful: like meditating, walking in the countryside, perhaps painting or other such tranquil pursuits. There is definitely a notion that certain activities are anti-mindful, including things like watching TV, commuting or social-networking. As with the idea that you are doing meditation wrong if you don't have a completely 'empty mind' I think this is a misconception which isn't helpful and which often leads people to beating themselves up that they aren't doing mindfulness properly (which really defeats the purpose!) Just as you can sit in meditation without being mindful at all, I think you can also be mindful as you are texting or surfing the internet.

Here I want to say what I think mindfulness is and why it is all about the way you approach activities, not the activity itself.

Mindfulness

Mindfulness is an idea which originated in Buddhism over two thousand years ago. It involves being aware of the present moment in an accepting way. The theory of mindfulness is that much of human suffering involves our being out of the present moment (going over things from the past or planning for the future) in a way which tries to make things different, and which takes us away from any awareness of the here-and-now.

I wake up in the morning and immediately remember something I said in a meeting yesterday which I am worried sounded foolish. As I make coffee and eat breakfast I am going over and over how I could have done it differently and what people will be thinking of me. Walking to work I am planning for the day, concerned about how I'm going to fit everything in. I'm brought back with irritation as someone pushes past me on the tube. At work each task I undertake I am concerned with getting it out of the way so that I can get on with the next one. I keep refreshing my facebook and twitter because I'm not enjoying the work. I start worrying maybe this job is no good. If only I worked somewhere else, then I would be happy. I spend the journey home daydreaming about a different life but the distance between my life and that one brings me down. Once home I switch on the television and escape into my programmes.

The practice of mindfulness involves deliberately cultivating the opposite to this habitual mode of being. Instead of wishing that things were otherwise, we try to be with them as they are with acceptance. Instead of going off into past and future, we try to stay in the present. And instead of missing what is going on around us, and in our bodies, we deliberately bring awareness to those things.

That explains why the basic mindfulness practice is just sitting still and paying attention to your breath going in and out. That is a good way of practising being in the present moment and being aware of the most basic aspects of experience. Also, our breath connects us to the world in a fundamental way, and it is always there, so it is a useful focal point. But the idea that we should have an empty mind while we are practising mindfulness is a misconception because the whole point is to be present to whatever is here in the moment. Inevitably that will include sounds outside, thoughts and feelings bubbling up, an itch or pain in the body. Mindfulness is about embracing all these things in a kind of spacious awareness: not latching on to any of them, but equally not trying to ignore them either. And of course we will find ourselves following a thought process that is just too sticky to avoid, or forgetting our breath when the building noise outside annoys us. At those times we just notice what has happened with interest, and the impact it has on us, and gently bring ourselves back to the breath.

The real, and only, purpose of practising mindfulness (whether we do it in sitting meditation, or slow walking, yoga, painting or whatever works for us) is so that we can bring that way of being into the rest of our lives. Again, this is no easy matter, and berating ourselves every time we realise that we are not being mindful is really not the idea!

Thich Nhat Hanh, who wrote The Miracle of Mindfulness, suggests that everyday tasks like washing up and eating a tangerine are good ones to practice bringing mindfulness into our daily life. And that makes a lot of sense because, like breathing, they are relatively simple activities which makes them conducive to that kind of accepting awareness of the present.

All activities can be mindful

However, I think it is important to realise that all activities can be done mindfully, and that is really what mindfulness is aiming for (without imagining that that is really achievable all of the time, which is why every now and again it is useful to stop and breathe).

So what of those activities which seem the furthest removed from mindfulness? Isn't television always distraction and escapism? How could day-dreaming ever be present when it is all about the future or the past? And surely it isn't possible to be mindful as we dip between email, facebook and twitter, skipping randomly from one thing to another without enough time to take any of them in?

I disagree because in terms of experience I feel that there is a difference between times when I'm watching TV as a distraction and times when I'm engaged with it. Or times when I'm aimlessly wandering around the internet versus times when I'm connecting with this person and that idea in a way that is present and open to each one. There are times when I can be fully present to a day-dream.

I suspect that we do all need some time in our daily routine when we are still, or focused on a very simple task, in order to observe our usual habits and to cultivate a more mindful way of being. But I also think we can bring that into the rest of the kinds of lives we have today, noticing when we have strayed away from it and kindly reminding ourselves to come back.

I wake up in the morning and sit for a while, noticing how I am drawn to thinking about that meeting yesterday and gently bringing myself back to the breath. Making coffee I enjoy the smell as I open the tin, the feel of the warm mug in my hand, the soapy water as I wash up afterwards. Walking to work I think over what I have to do in the day and notice a knot of stress building. I gently bring myself back to the tube, sharing a smile with a fellow commuter as we do-si-do out of each others way. At work I take time to check in with a colleague, wryly noticing my desire to ask whether they thought I was foolish in the meeting yesterday. I think about which task I'm most in the mood for and enjoy devoting a couple of hours to that before moving on to less interesting things. In a break I enjoy the free-floating sense of dipping around facebook and twitter, and focus in on a couple of posts that interest me, enjoying the brief connection with someone on another continent who is thinking about such similar things to me today. Walking home from the station I enjoy a daydream about an imaginary party with all my favourite fictional characters. I can feel the evening air on my face and see the people walking past me at the same time as I'm sharing cocktails with Elizabeth Bennet and Hank Moody. Back home I make myself a meal, noticing the colours, smells and textures of the vegetables as I chop them. I close the curtains and watch an episode of my favourite show, enjoying the sleepy cosiness of the end of the day.

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Suggestions for Fear and Sadness

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Edited by Meg-John Barker, Wednesday, 17 Aug 2011, 16:52

 

Suggestions for Fear and Sadness

Understanding Counselling & Psychotherapy

My main job at the Open University since I started working here in late 2008 was to produce and present a module called Counselling: Exploring Fear and Sadness. As part of that process my colleagues Darren Langdridge, Andreas Vossler and I edited a textbook which brought together experts on all different types of counselling to say how their approaches would work with fear and sadness.

When we wrote the book I thought that it would be great to do another book covering the same areas, for people who are not interested in studying counselling themselves but who just want to know about what different kinds of counselling suggest. As Mick Cooper and John McLeod have recently pointed out: different things work for different people at different times, whereas most books on the market cover just one approach in detail. Maybe I'll write that book one day, but meanwhile here are what I personally think are the top suggestions from each chapter of the book we did write. If you find them useful of course you can always do the whole module (D240) through the OU.

1 - Introduction

Remember that everyone gets frightened or sad, and everyone also has times in their life when this becomes overwhelming. There is not really an 'us' (the professionals) and a 'them' (the clients or patients) because all people will find themselves both in the position of struggling and of helping others who are struggling.

2 – Diagnosis

We used the words 'fear and sadness' rather than 'anxiety and depression' for the module because there are pluses and minuses to the more diagnostic categories. It can be useful to think about what is gained, and what might be lost, from taking on such labels. For example, they can make it easier to find others who are in a similar situation, to access support, and to feel legitimate in what you're experiencing. But they can also mean being stigmatised by others or feeling as if you are stuck this way for good. Diagnosis can also be more or less useful for different people at different times, and doesn't have to be the way you see yourself forever.

3 – Drug treatments and the biopsychosocial approach

People often link diagnosis and medication. It can feel like either you have an illness, you take drugs and therefore it is not your fault that you are struggling, or you don't have an illness, you don't take drugs and therefore it is your fault and you should 'pull your socks up'. That's a really unhelpful (but sadly common) way of looking at it. We become overwhelmed by fear and sadness for all kinds of complex reasons involving our bodies, our background, things going on in our lives, and the world we live in. Drugs can certainly help some people at some times, but taking them doesn't mean you can't do anything for yourself as well. And deciding that you don't want to take drugs doesn't mean you are struggling any less or don't need support.

Interestingly the one thing that everybody we interviewed for this module agreed on (including celebrities like Trisha Godard and Stephen Fry) was that some form of physical activity had helped them immensely. It can be really hard to do when you're feeling bad, but well worth keeping in mind just how beneficial it can be.

4 – Psychoanalysis

I'm not a great fan of psychoanalysis myself, but the chapter that Ian Parker wrote on this topic for the book was a real eye-opener about the starting points of the 'talking cure' of counselling. I loved Freud's metaphor that we are like those 'magic slate' toys which kids have.

Magic Slate

When things happen to us it is like writing on the front layer of plastic. Then that gets wiped clean, but there are still traces of the writing on the wax behind that will have an impact on whatever we try to draw next (the lines will get a bit broken and distorted). Freud believed in the value of exploring what there is back there on the wax layer which is affecting us now. And I think that is valuable as we often find ourselves responding to current events in ways that are hugely influenced by what has happened in the past. Making sense of that can help it to feel more manageable and understandable.

5 – Humanistic counselling

A key concept here is empathy. Can we cultivate empathy for ourselves and for other people? Carl Rogers proposed a challenge where each time you speak – in an argument or discussion – you first have to restate the ideas and feelings of the previous speaker accurately and to their satisfaction, before you get to have your say. This might seem a long way from fear and sadness, but many authors are now seeing compassion as centrally important in these areas. If we can learn to be more understanding and kind in our interactions with others we end up feeling less alienated from them, and it also helps us to recognise that it makes sense when we struggle as well, and that we also deserve kindness. When people are feeling really distressed one of the best things they can do is just to make sure that they do one kind thing for themselves every day. It helps to remind them that they are as worthy of kindness as everyone else.

6 – Existential counselling

Existential counselling challenges our common idea that there are good emotions (joy, pride, happiness, etc.) and bad emotions (fear, sadness, anger, etc.) Rather it sees all emotions as important parts of human existence. When we have to make choices we often experience deep anxiety but that is part of embracing our freedom and really living. Similarly there are inevitably points when it all feels too much and we give up and retreat from the world. Existential therapist Emmy Van Deurzen suggests that emotions are on a kind of compass, from happiness (North) through anger (East), down to sadness (South), and back up through hope (West) to happiness again. We move endlessly around that circle – like it or not – so it is worth understanding all those states, and what we get from them as well as what is difficult about them, rather than trying hard to avoid some of them which means we might well get stuck in one place.

7 – Cognitive-behavioural therapy (CBT)

When we find something frightening or depressing we tend to avoid it, but often that leads to it becoming more scary or saddening rather than less so, and we can then become quite paralysed. Our world narrows as more and more things seem difficult. A very basic CBT idea would be to gradually approach the things that scare us rather than avoiding them (starting small and working our way up). Another useful CBT technique is to pay attention to the little negative thoughts we have throughout the day – like an ongoing commentary – maybe noting them down as we are aware of them and challenging each of them. Is it really realistic? What alternative explanations are there? Is it useful? How might I think about this differently?

8 – Mindfulness

Make a little time every day just to sit somewhere peaceful and breathe. The idea is to be comfortable without distractions and just focus on the sensation of the breath going in and out of your body. You will find that you keep getting carried off on thought processes and distracted by sensations and that is absolutely fine. Just notice that it has happened and bring your attention gently back to the breath. Notice how the thoughts and feelings bubble up and then pass away again eventually if you don't get too stuck to them. The idea in mindfulness is that if we practice doing this regularly we will start to be able to bring the same accepting awareness to whatever is going on in the rest of our lives.

9 – Systemic counselling

The fear and sadness we experience feels like it is inside us and that there is something that we need to do individually to change it. Systemic counselling proposes that actually much fear and sadness is really in between people, in families, relationships, and groups of work colleagues. Think about your own dynamics with people you are close to: do you tend to bounce off each other sometimes in ways that leave one or more of you feeling bad? A nice exercise from systemic counselling is to take some different shaped stones or modelling clay and make a model of your family or group, representing each person as an object, and where they are in relation to each other, by the way you position them. Then you can move it around to show how you would rather it was. This can help you to be aware of how the dynamics in relationships can get stuck and also how they might shift.

10 – Sociocultural issues

Similar to systemic counselling, sociocultural approaches remind us that a great deal of our fear and sadness are about the culture surrounding us and how we are viewed within it. Being marginalised is strongly linked to experiences of distress, and we all occupy multiple sociocultural positions (in relation to race, gender, sexuality, age, class, (dis)ability and so on). It can be useful to reflect on which position you are in on all of these dimensions and what the assumptions are 'out there' about people like you. Do your experiences of fear and sadness relate to those assumptions at all? Are there ways of sharing these with other people who are in a similar position?

11- Context and setting

This chapter was all about counselling over the phone and online. One idea from it was to write about a time when you were feeling particularly sad or frightened – noting down what was going on and how you felt about it – without thinking about it too much. This was really an exercise to think about how people express their emotions online or over email, but actually researchers like Pennebaker have found strong evidence that writing regularly about our feelings is hugely beneficial. Private blogs and personal journals can be a helpful way of doing this.

12 – The therapeutic relationship

This chapter explored how different types of counselling involve different relationships between the client and the counsellor. Many people who decide to go for counselling don't realise how many different types of counselling there are, and how they will all involve very different kinds of relationship and quite different focuses. I wrote a bit about the different counselling approaches here. It is definitely worth thinking about what would work for you and asking counsellors about their qualifications and approaches before committing to it. You should always make sure that they are accredited with one of the major bodies (e.g. BACP, UKCP, BPS). If in doubt, ask.

13 – Outcome research

As well as finding out about what approach might suit you, it is also worth checking out the research that has been done into the kind of counselling you're thinking of going to. Mick Cooper's book on this topic is very accessible if you are interested, and even online searches can give you some idea of whether the kind of counselling you're considering has been found to be helpful for the kinds of issues you have. However...

14 – Process research

...perhaps the main research finding about counselling is that all of the main approaches (covered in this book) are generally about equally effective (with some exceptions like CBT being particularly good for simple phobias). According to the research, a good relationship between client and counsellor is one of the main things which predicts how useful counselling will be. So it is worth shopping around for someone you have a good rapport with. If you are accessing free counselling it is still okay to ask for a different counsellor if you don't feel a good relationship with the one you have.

15 - Conclusions

There is always a risk with going to a counsellor that this will reinforce the idea that many of us already have that there is something wrong with us that needs fixing. Our commercial culture is very good at giving us a sense of anxiety about the things that we lack, and selling us products to relieve this anxiety. In this culture it is all too easy to think that we are not good enough. Therefore it is important to remember that going to get some support or talk through what's happening doesn't mean there is anything inherently wrong with you, and also remembering that counselling is just one of many ways of thinking things through, looking after ourselves, and getting support.

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