Emotional Intelligence, Mental Health, self-perception

Why are you so petrified of silence?
Here can you handle this?
Did you think about your bills, you ex, your deadlines
Or when you think you’re going to die?
Or did you long for the next distraction?

Alanis Morrissette, “All I Really Want” (1995, Maverick/Warner Music Group)

Decades ago, when I first tried meditating, I could not sit for more than a couple of minutes at a time. A dozen or so years ago, when I finally got serious about the practice, I could finally get past the physical fidgets and sort myself out around chronic pain, but I couldn’t get around the Squirrel Brain for the longest time. The silence, as “they” like to say, was deafening, and my own thoughts would often redouble their efforts to drown it out.

Often, in the silence when I’m trying to fall asleep, I tell myself stories that are half Mary Sue fantasies, and half a way of setting up semi-lucid dreaming as I transition into sleep patterns. They often run on recurring, familiar themes with recurring, familiar characters, like favourite bedtime stories read to us repeatedly in childhood.

These two pieces of information are the backdrop to an experience I had in a guided meditation last week, during a training course in working with internal Parts. As part of the meditation, we were invited to notice what aspects of our thoughts or feelings wanted to follow us on this path in towards silence, and gently encourage those heel-dogging experiences to wait off to the sidelines and give us some space. It’s a lot harder than we think to try to distance ourselves from our own thoughts and feelings; even as a relatively seasoned short-term meditator, I still struggle with intrusive thoughts that just don’t like being ignored. And I don’t mean “intrusive thinking” the way we often do in psychotherapy; I just mean the kinds of everyday thoughts we have about things we need to do, meant to do, random memories, feeling flashes and reflections on things that happened in the day—the usual jibber-jabber of mental cognitive load.

As I engaged in the meditation, I managed to get most of the regular Intruders to fall away, and I was good for a while. But there’s a part of me that shows up, especially in the calm and quiet moments, that starts to spin up stories. Sometimes I think of this part as my Muse, and like typical Muse Moments they always seem to show up when I am least equipped to make notes about what might be a good storyline to flesh out; once a Writer, always a Writer, after all. One ignores the whimsical and fleeting visits by their creative Muse at one’s own peril. Sometimes this part simply likes to provide some internal companionable distractions to the quietness around me. It’s generally a soothing presence, more in line with calming me than getting me fired up with creative sparks. The version that showed up in the meditation definitely had this latter energy. And while it wasn’t necessarily the bent of the exercise to converse with our Parts when we’re supposedly walking towards Silence, I still opted to get curious about what it was doing here.

This part of me has been around since early childhood. Since I was old enough to understand and appreciate people reading to me or making up stories. I don’t have any specific memories of either of my parents reading me bedtime stories, but I know it must have happened as both my parents were avid readers and encouraged my own reading. Both my parents were also alcoholics. Once they drank themselves into a stupor, they would retreat to their separate spaces and not talk to themselves, each other, or me. There was a LOT of silence in my home as I was growing up. Most of my memories of childhood Christmases, for example, are of them starting with Galiano and vodka in the orange juice and being separately passed out by early afternoon. I would escape into the books I inevitably received that morning or was assembling my own toys. The house would be silent, and those stories would be the place to which I could flee and find companions, and engagement, and solace. I spent a lot of time alone as a child; on a farm until I was 7, and in the small town I grew up in from 8-19 (though at least in town I could and did make friends I could spend more time with, perilous and political as childhood and teenage relationships could be).

Silence was also a herald of uncertainty and instability for me: I never knew what kind of adult was going to come out of those silences. Was it going to be “drunk and hyperfocused on me”, “sober and hyperfocused on me”, “emotionally estranged and distant”, “calm and friendly”, “angry and antagonistic at each other”, “angry and antagonistic at me”, or any one of a random number of other states common to alcoholics. Escape into the stories I could explore in the silence gave me consistent refuge, and that was so invaluable to me as a child and teen, and probably explains why some of the inner-world storylines I developed in my younger years are still so strongly with me even well into my adulthood.

Most people have some kind of Storyteller part, often an intellectual, “thinking” part. This is the part of us that narrates or describes an experience we’re having, rather than standing down and allowing us to be fully in the emotional experience of the moment. Intellectualizing an experience often feels more normal, or even considerably safer, than allowing our feelings to come to the surface. Sometimes the Storyteller is our fully human need to make sense of a set of confounding circumstances, connecting the dots (rationally or not) to create a narrative that makes sense at least to us, if no-one else, that we can run with as if it were incontrovertible FACT. Sometimes this Storyteller part is so strong that it retells the same story, over and over until it is a well-polished, almost scripted delivery.

Years ago, my friend and Dora-award-winning actor and director Philip Akin shared this piece of perspective on directing Shakespeare. He said you can always tell when an actor has no clue about the meaning of the words coming out of their mouths, because they simply seem to “drop out of” the lines, and if you know what to look for as a director, it’s an easy thing to spot. The words are there, but the presence of the character or actor inside them just disappears for a moment. I began to notice that in my work as a theatrical director and at some point, in the clinical office, I began to notice that with my clients as well. I could more readily spot when something they were saying to me felt like that polished script, because emotionally they would kind of “drop out” in the same way actors do. I started to get curious about what those words meant to them, and sure enough, more often than not I’d get variations on the theme of, “That’s just how it’s been for years.” They have created such a familiar and refined narrative that they can safely disconnect any emotional content from the words and recite the words now without any risk of recurring pain from vulnerable and tender lived experience.

Now I know that in the moment, I’ve been in the presence of their Storytellers. These are the parts of their internal processing system that carry the load of explaining their internal experiences to the outside world in ways that seem palatable in whatever ways seem necessary to that external audience. These recitations have become polished deliveries based on repetition and refinement based on the speaker’s perception of how Others are receiving and responding to those stories. We tweak the recitations to elicit some specific responses and minimize others, thus controlling the engagement and/or the environment in which we are ostensibly revealing some quasi-vulnerable part of ourselves—this identifies the Storyteller as what Internal Family Systems terminology recognizes as a Manager. Its job is to mitigate outward circumstances that could lead to harm, for example by controlling the narrative during disclosures, or (as in my case) protecting a child from the pain of isolation and profound loneliness.

It was lovely to have a few moments alone recognizing the presence, and now appreciating the workload, of my own Storyteller. It was nice to have the container of a silent meditation in which to walk alongside it and allow it to put down the work of keeping me calm and distracted and safe; I was able to show it where I was in life, and how I have learned to appreciate silence very much in my life (rampant Squirrel Brain during my own meditation notwithstanding). My Storyteller seemed to appreciate that understanding and was quite happy to walk along with me without needing to spin a yarn as if to keep a small child entertained. It was a lovely moment.

Do you have an internal Storyteller? Are there polished pieces of your own experiences that you keep reciting time and time again? Is there a part of you that prefers to think its way through experiences rather than feel them? Are there rich, old narratives that flow into those silent moments to accompany you when the silence feels somehow like it’s too much? What else might you be wary or afraid of encountering in those moments of silence?

Emotional Intelligence, Mental Health, Self-Development, self-perception

[I wasn’t going to write a post today because I’ve been sick for a week, but the kernel of this one appeared in my head at 2am two nights ago as the Ick was finally starting to loosen; as every writer knows, when the Muse shows up, you shut up and write what she tells you to write.]

The scene: a comfortably furnished counselling office on a weekday evening; seated as far as they can possibly get from each other on the tufted velveteen sofa, a man and a woman. Across from them, quietly observant, their therapist.

Woman, angrily: How can you not see what’s happening right in front of you? I am SO FUCKING TIRED of feeling like all of the relationship shit falls on MY shoulders to manage for us both! I feel like you don’t even know what it takes to be in a partnership with someone, and I’m so resentful now that I’m the only one trying to make anything better!

Man, pleading: I know you’re unhappy! I don’t know what to do! Can’t you just tell me what you need me to do??

Woman: I need you to step the hell up. Do the fucking WORK.

Man, turning to the therapist, hands dangling limply between his knees, defeated: I don’t even know what that means.

Woman: [throws up her hands, exasperated]

Most of us who have done couples work will have seen variations of this scene play out time and time again. Even if we’re working with individuals, we’ll often hear variations on statements like, “I need (or need someone else) to DO THE WORK”, or “I don’t know what DO THE WORK actually means.”

So… How is it that some of us know what this phrase, “Do the Work,” means, and some of us don’t?

Usually, it boils down to something simple: it’s a commonly used (some might suggest “overused”) phrase that has come to mean a lot of different things to different people, and while you may have an idea of what it means to YOU (whether you have even a vague clue of HOW to do the Work or not), you may have no idea what someone ELSE means when they’re shouting it at you in anger or frustration or disappointment. All you’ll know in that particular moment is that whatever you have been doing, clearly hasn’t been working.

You need something TO work. You might even need to DO work to change things, hopefully for the better. But you have no idea what that actually entails. If you’re on the receiving end of someone’s demands to “do the Work,” the message you’re probably hearing is, “Everything you do sucks and why can’t you just magically and instantaneously be a better lover/partner/spouse/friend/parent/sibling/whatever??” I can guarantee that’s not ACTUALLY what your partner is trying to communicate to you, but by the time you end up in my office (or one like mine), you’ve probably heard frustrated iterations of this messaging so often that you can’t hear them as anything else. And if you’re on the delivering end of this message, it probably means something to the effect of, “You need to change so I feel better, and you should just magically intuit what I need that to look like from you.” And I can also guarantee this kind of approach is setting up everyone in the relationship for mountains of frustration at best, and catastrophic sabotage at worst.

So… what is “the Work”?

In an introductory note to her book, How to Do the Work, Dr Nicole LePera describes, “A long, rich tradition of the work of transcending our human experience […]” involving “the pursuit of insight into the Self” and the development of “tools to understand and harness the complex interconnectedness of your mind, body, and soul.”

Or, as we like to say in The Biz, “Figuring your shit out.”

By the time someone(s) gets into a therapist’s office, especially from the perspective of relational conflict, “the Work” means “learning how to see and understand how your own patterns of thinking and acting are (negatively) impacting your life and/or the lives of those around you and changing those thoughts and behaviours in positive ways.” While it’s not entirely true that knowing is half the battle, admitting there’s a problem in what you’re bringing to the table is kind of a crucial starting point. “You can’t fix what you can’t see” is only nominally less true than the idea that you can’t fix what you WON’T see. At its core, “doing the Work” means first learning to see and accept that there IS a problem in how we engage in the world, then figuring out how to improve the ways we engage.

I often break the Work down into the following stages of personal development, each with its own subset of tools and tactics and potential revelations:

  • Self-observation (looking inward at our own internal workings with genuine, nonjudgemental curiosity)
  • Self-reflection (thinking critically – as opposed to simply being self-critical – about what we perceive when we look inward, exploring where those thoughts, feelings, behaviours come from)
  • Self-connectedness (this is a new piece of the process in my approach, because I realized the skillset for seeing and understanding how our individual existence impacts others in systems around each of us is its own piece of Work)
  • Articulation (the ability to communicate what we’re observing and learning to the Important People in our lives is a skill unto itself)
  • Implementation (navigating the actual iterative change processes within ourselves and our relational systems)

The Caveats of “The Work”

Jessica Grose, Opinion writer for the New York Times, encapsulates a lot of the current backlash against the phrase itself and what it has come to mean in pop culture, in her article, ‘Doing the Work’ and the Obsession With Superficial Self-Improvement (New York Times online, June 3, 2023; free account subscription required):

I confess a visceral aversion to “doing the work” used in this particular way. My gut reaction is: I simply decline to do more work. My life is already filled with many kinds of labor. I work full time; I cook dinner every night; I shuttle my children to and fro. I’m not asking for a medal here. This is just what’s in many people’s inboxes. But does tending to my mind and soul have to be framed as yet another job, another box to check, another task to optimize and conquer?

I asked [The New Yorker journalist Katy] Waldman over email what she made of my aversion. She also finds “doing the work” a “uniquely annoying phrase” and explained that it “can come off as patronizing.” It implies that our big issues in life “are simple and clear-cut, that everyone agrees on what they are and that the only reason a problem hasn’t been solved is because somebody isn’t working hard enough.”

Jessica Calarco, an associate professor of sociology at the University of Wisconsin, Madison, had a similar take. “This idea of ‘doing the work,’ is just the latest manifestation of the kind of self-improvement culture that has long permeated American society and that is closely linked to America’s obsessively individualistic bent,” she told me via email. Self-improvement culture can deny the larger societal issues that often cause people strain, and it “can lead us to punish people who are struggling or deny them the support they need,” Calarco wrote. Therapy is expensive, and having time in your day to reflect can be a luxury, something that’s rarely mentioned when “doing the work” is used.

These are all good and valid concerns around the way the terminology has evolved culturally over time, especially both the connotations of Yet More Emotional Labour, and the chilling divisiveness when the term is used to dismiss those who haven’t done some unclear amount of said emotional labour towards self-betterment. I remember reading a science fiction novel decades ago—I don’t remember anything else from the book except this particular plot point—that made a sharp class distinction not between the rich and the poor, but between the Therapied and the Untherapied, and all the snobbish, snubbing judgement you’re probably already reading into “Untherapied”.

The opponents to the terminological hijacking are dead right; therapy IS expensive, and for a lot of people, time to reflect IS a luxury. Being asked to take on more emotional labour IS going to be a big NOPE for a lot of people. As I have written often throughout the years in the blog, change IS hard, and some will work their asses off for literal YEARS in or out of therapy for the smallest of incremental changes. Other people can read one self-help book and suddenly seem like they’ve seen into all the deepest secrets of the universe**.

I am always honest with my clients when I’m explaining what this loaded term means in MY office, and how I approach being a guide/coach/teacher/companion/witness/emotional sherpa for my clients doing their individual versions of the Work: I have NO idea what the Work will look like for each of you. I have NO idea how long it will take you. Until we do the Gap Analysis to understand what resources are already available and which might be lacking or needed to reach the goals you set for yourself, we really have no framework in which to understand what Work is necessary. And even once we do start to fill in those gaps, a lot of the Work isn’t going to be silver bullet-level magic fixes; it will be trial and error, assessment and adjustments based on what you learn along the way and over time.

And that can be disheartening to hear for people who come to therapy believing that just walking through the door is enough to check a box labelled “Did the Work”. Therapists have a name for the broad category of potential clients who come in once or twice to try on the idea of changing things in themselves or their relationships but decline to take on the process, or maybe aren’t even ready to admit yet there IS a problem, let alone they might be the source of it; we refer to these kinds of potential clients as “precontemplative”, taken from the Transtheoretical Model of Change. Not everyone who comes into therapy is ready to change, and we must respect that. Not everyone who is ready to change comes equipped with the tools for change, and we must respect that, too. Sometimes before we can build a house, we must make the tools with which to build the house.

The onus is on us as therapists to be honest about these realities, and to be clear about both how we define the Work, and what we bring to the table to help our clients in that Work. But once we’ve gotten that straight and mostly clear… the responsibility then shifts entirely onto the client to (you guessed it) Do the Work.

(**—someday I will tell the story of how Gloria of Sainted Memory unleashed the self-developmental equivalent of The Big Bang the day she put into my hands my first copy of Bennet Wong & Jock McKeen’s The Relationship Garden. That story is not for today, but it is an excellent example of how “doing the Work” can literally become a lifelong endeavour.)

Emotional Intelligence, Mental Health

I’m a big believer in the notion that we all HAVE feelings. I’m even a big believer in the idea that we all FEEL feelings. I also happen to have a front-row seat for the myriad ways human beings try REALLY, REALLY HARD a lot of the time to AVOID feeling their feelings, especially the difficult, rowdy, dark, threatening ones.

A favourite avoidance mechanism for many of us (yes, myself included) is to subvert feelings we don’t want to have into actions that make us feel better, at least in the short term; for example:

Sad => Eat
Sad => Shop
Depressed => Sleep
Anxious => Clean

It’s the short-term, pleasure-seeking action into which we channel our temporarily imbalanced emotional state that might, indeed, work in the short term; it never seems to get at the root of whatever’s prompting those feelings in the first place, though. It turns us into what someone (I can’t now remember who) once termed, “Human Doings, not Human Beings.” How many of us recognize the phrase, “I eat my feelings”? That’s subversion.

Another common reaction to the feelings we don’t wanna feel is scapegoating:

[T]he practice of singling out a person or group for unmerited blame and consequent negative treatment. Scapegoating may be conducted by individuals against individuals (e.g. “he did it, not me!”), individuals against groups (e.g., “I couldn’t see anything because of all the tall people”), groups against individuals (e.g., “He was the reason our team didn’t win”), and groups against groups.

A scapegoat may be an adult, child, sibling, employee, peer, ethnic, political or religious group, or country. A whipping boyidentified patient, or “fall guy” are forms of scapegoat.

Scapegoating has its origins in the scapegoat ritual of atonement described in chapter 16 of the Biblical Book of Leviticus, in which a goat (or ass) is released into the wilderness bearing all the sins of the community, which have been placed on the goat’s head by a priest.

from Wikipedia

René Girard aptly describes how scapegoating becomes an outlet for feelings we can’t or don’t want to examine within ourselves for the ACTUAL source of them:

In a world where violence is no longer subject to ritual and is the object of strict prohibitions, anger and resentment cannot or dare not, as a rule, satisy their appetites of whatever object directly arouses them. The kick the employee doesn’t dare give his boss, he will give to his dog when he returns home in the evening. Or maybe he will mistreat his wife and his children, without fully realizing he is treating them as “scapegoats.” Victims substituted for the real target are the equivalent of sacrificial victims in distant times. […]

The real source of victim substitutions is the appetite for violence that awakens in people when anger seizes them and when the true object of their anger is untouchable. The range of objects capable of satisfying the appetite for violence enlarges proportionally to the intensity of the anger.

Girard, I See Satan Fall Like Lightning; 2001, Orbis Books, NY

Projecting our feelings onto others isn’t new; nothing abhors a vacuum more than the human brain, not even Nature. So when we don’t understand why we feel what we feel–or we don’t want to look at why we might feel as we do–it’s sometimes MUCH easier to scan around for an easier target and make them bear the emotional burden for us. In taking those feelings out on the unsuspecting victim, we complete the ritual of metaphorically driving our burdens out into the desert to perish somewhere far, far away from us and our shame-stirring occupancy of those emotions. It’s devastatingly destructive on relationships, however–trust me on this one, I’ve personally lost entire marriages to not recognizing this pattern in time. (I had an excellent therapist who helped me figure it out afterwards, at least.)

A third way we often create distance from our own feelings is something I recently labelled as “surrogate catharsis.” A client was telling me how they often watched episodes of “Grey’s Anatomy” for the soap-opera-ish melodrama that readily provoked great, heaving snot-filled sobfests the client could not otherwise allow themselves to express. It called to mind a lesson observed a very long time ago in the BDSM community, where I learned that bottoms/submissives/slaves can use the often-ritualistic container of a scene, or playspace, or a Dominant/submissive relationship, to express things we can’t always express in the other contexts of our lives. We can scream out the rage and pain, we can struggle hard against the bonds, we can let go of higher cognitive function and allow ourselves to fall into certain physical sensations, we can cry and sob and beg and plead and just generally let go of the behavioural constraints to which we normally cling.

A surrogate is a person or thing we substitute for another in the same role. Like scapegoating, but so unlike scapegoating, the mechanics of surrogacy are somewhat similar. For a variety of reasons, we cannot or don’t want to access our own feelings directly; this is fairly common with clients who bear the scars of profound trauma (or are still immersed in ongoing trauma scenarios). We are aware of the buildup of pressure alongside these unwelcome feelings, however, and seek to find a way to release the pressure without ever actually accessing the feelings and/or their roots directly. Unlike scapegoating, however, we don’t project those feelings onto another and then follow up with punitive measures. Instead, we actually allow ourselves to experience the feelings but in a different association than their actual origin. We can feel, and we can express, but it’s almost directed harmfully AT another… and it’s almost never connected to directly processing our internal traumas. For some of us, we achieve surrogate catharsis when we read or watch something that gives us permission to cry. Unlike the act of subversion from the top of this page, we choose acts that DO access and express our feelings, we just don’t connect them to their sources.

Some people default to a particular method of rerouting their emotional experiences. Some of us will move between all three as circumstances dictate. In many cases, these are self-defensive mechanisms designed to protect us from what we instinctively believe to be threatening experiences. In a lot of cases, these defences have become maladaptive and problematic for the person or their relationships. We create barriers between our day-to-day cognitive functioning and our emotional experiences for a lot of reasons, but chiefly because we’re taught to be afraid of, or to doubt the veracity of, our feelings. But feelings are most often just our brain’s way of running a flag up the pole to indicate, “Hey, You–something is going on here that needs tending to.” Therapy can often help people learn to connect safely with their own feelings, and find ways of both allowing them to surface without so much overwhelm, and choosing different default actions when they are present.

To borrow from Cognitive-Behavioural Therapy for a moment: Feelings are not Facts. They’re just a transient internal experience of the situation, the context, of this moment. When we deflect away from them, however, whether we subvert, scapegoat, or surrogate them, we can often give them more power and influence over us (or others) than they deserve. As a closing meditation on the transient nature of even the most overwhelming feelings, I offer my favourite poem by the Sufi poet, Rumi (translated by Coleman Barks):

This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

Emotional Intelligence, Mental Health

[Before all else, I will add this clarification: This is an opinion, albeit one informed by years of clinical observations of my own clients: those who self-identify as neurodiverse, those who self-identify as neurotypical, those who aren’t entirely certain where they fall, and perhaps mostly those who VIOLENTLY reject the notion they themselves might be on the spectrum somewhere.]

The human brain likes to organize and categorize things. Human culture likes to organize entire groups of people into “Us” and “Them”, then create entire arbitrary systems of values and rules and justifications tied to the perceived differences between those who are Us, and those who are Them. We see exactly the same kind of almost tribalistic distinctions between Those Who Are “Mentally Well” and Those Who Are “Mentally Ill”, and even when science moves to recategorize what used to be seen as mental illness into different forms or levels of executive functionality, humanity still very much adheres to those differentiating Us and Them labels.

With the re-examination of what we now term “neurodiversity” in the past decade, trying to better understand executive functionality in its much-broader-than-anyone-ever-realized scope, I often see through conversations with my clients the not-always-subtle pushback in our culture to the idea that a wide-ranging selection of behaviours tied to executive functionality might be way more prevalent than we thought. There has been a strident demarcation between the Us that can function without those disruptive behaviours, and the Them that seem persistently plagued by them; the affected neurodiverse (ND) who struggle to mesh with the world around them, and the “normies” who adhere to the notion of being “neurotypical” (NT). “I’m not like THAT,” “I’m not broken,” I’m not CRAZY”–therapists hear these kinds of statements all the time, just as we hear from the other side, “Am I broken?” “Am I crazy?” Why is this so hard for me and so easy for everyone else?”

Almost a decade since the first ND folks walked into my office, and now five years of working more closely with ND folks of many stripes, through my clinical observations and interactions I have come to a singularly compelling conclusion:

The concept of “neurotypical” is complete and utter bollocks,
a damaging, tribalistic myth of epic proportions.

There. I said it.

I deal with a lot of adults who are officially diagnosed with ADHD or autism.
I deal with a lot of adults who are self-diagnosed with ADHD or autism.
I deal with a lot of adults who regularly present with behaviours consistent with ADHD or autism.
I deal with a lot of adults who periodically or infrequently present with behaviours consistent with ADHD or autism.
I deal with a lot of adults who regularly present with maladaptive behaviours consistent with exposure to/immersion in high ongoing or repetitive stress or overstimulation (including burnout).

Guess what? One group, the first listed here, has an official diagnosis of some form of neurodivergence. The second is willing to see themselves as such. The other four? Statistically most likely to self-identify as neurotypical. You know what they all have in common? They all share the same types of dysregulated emotional reactions and behaviours when pushed past their respective breaking points. The breaking points’ locations differ for each group, but they can be mapped on a very uncomplicated two-axis graph with GROUP on one axis and STRESS on the other.

What this means, then, is that under the right set of circumstances, WE ALL exhibit the same dysregulated responses to stress and/or overstimulation.

TL;DR: pushed past certain points, WE ARE ALL NEURODIVERSE.

Take THAT, stupid tribalism!

So what’s happening for us then that puts us all on the same spectrum of executive function but at vastly different points of regulation? Turns out, the variable factor is the Window of Tolerance, or what I’ve been calling “tolerance capacity”.

The primary difference between the folks who claim to be “neurotypical” and those who don’t is their capacity to process stimulation. Stimulation past a certain point starts to exact heavier and heavier tolls, becoming stress. Stress surpassing tolerance levels starts to wear us down into a variety of hypoarousal and fatigue states (this is often where we see our burnout clients showing up). Stress and overstimulation that continue for many people into breakdown zones will eventually result in dysregulated responses; the tolerance window for NT folks is simply higher or wider, on average, than most ND folks whose overstimulation can start as soon as they wake in the mornings.

The reason why I would most like to strike the myth of “neurotypical” from the records is the damage done by any system that presents a mythical standard of high moral value, then subjugates a vast swath of the population into the OTHER group: “NEUROTYPICAL is GOOD, anything that DIVERGES from GOOD must therefore be BAD; therefore NEURODIVERSE is BAD.” Trust me when I say, it’s been a LONG struggle just to get language shifting from “Neurodivergent” to “Neurodiverse”. “Divergence” still carries the stigma of “diverging from the NORM”, which is hugely problematic when we can increasingly prove that “normal” is a mythological crock of shite. A lot of ND folks have brought in their frustrations and terrors around encountering time after time the messages that they are perceived as somehow less than, broken, crazy. They’ve been gaslit for generations into believing they are mentally ill, or at least deficient somehow; the ongoing stigma attached to neurodivergence is part of why the Tribe of Neurotypicals clings so desperately to the Great Myth of Normalcy.

Most of us have a window of tolerance, even the advanced autistics; it may not be as big as yours or mine and it almost certainly looks very different from anyone else’s window. We generally each have SOME capacity to tolerate stimulation or stress, but our ability to tolerate can shift dramatically, even from one moment to the next; it can shift up or down the Stress axis, it can grow or shrink. It is definitely impacted by the number of stress/stimulation sources in our lives. Some folks thrive in high-stress environments indefinitely because they have high-capacity tolerance windows; others are grumpy as soon as they wake to the weight or feel of their own bedsheets against their skin, and tolerance windows only shrink or move downward from there.

So instead of firmly and proudly declaring yourself in the camp of Neurotypical, I would ask you to remember a time when you maybe lost control emotionally or physically; how did you react? Did you feel overwhelmed, or distraught? Were you thinking clearly, acting your best Executive Self? How many times in your life has that happened? It’s important to reflect on these moments; these are the experiences that put us all on the same spectrum. There are a lot of great resources to help you understand how your own window of tolerance operates, starting from the seminal works of Dr Daniel J Siegal (described in the video link below), and how to be better at regulating yourself in the moments where those neurodiverse behaviours signal moving out of your optimal range. Even if we don’t bring the angle of Neurodiversity into the office, therapists are often well aware of a client’s executive functional state and capacity; we’re constantly working in various ways to help grow a client’s tolerance for a variety of stressors (whether this winds up looking like “tolerating in place” or “tolerating change” around those stressors).

Rethink your understanding of the myth of Us and Them. There are no camps here, just a spectrum of tolerance capacity and some beautiful, mobile windows into each of us on it.

Mental Health, Therapy General

(Sitting down this morning to write be like, “Okay, what do I feel awake and caffeinated enough to tackle this morning, writing a plausibly-coherent blog post, or trouble-shooting my office technology? …Ah, guess I better write that post, then.”)

In an entirely non-scientific polling of my own personal FB feed, “what to expect from a first session” and “red flags for choosing a therapist” were two top requests. I don’t often write about the technical aspects of sessionwork simply because there are almost as many variants on the “how” as there are therapists in the field. “How” is then dependent on their individual style, possibly the modalities they practice, definitely any policies of the practice in which they work (especially applicable to groups, agencies, and larger or corporatized organizations, like hospitals and clinics). There are a lot of articles available on the topic of what to expect and on the subject of spotting red flags in your therapist.

As a friend pointed out, this being my blog, maybe it would be useful to describe a little of my own process. (I will point out the irony of running with that suggestion, given that a therapist talking predominantly about themselves is a Big Red Flag, but hey, you’re not paying me for this hour, so Imma take the mic for a while 🙂

Pre-session, there are different ways in which clients contact me in both my solo practice and through Bliss Counselling. In my solo practice, clients contact me directly, usually by email, and I get a chance to ask for a VERY high-level idea of what kind of issues they’d like to work on, so I get a sense of whether or not those subjects are in my wheelhouse, and then I will email them my own intake forms. At Bliss, our wonderful admin staff are the first line of contact, so they’ll ask those questions on the therapist’s behalf, possibly help incoming clients set up a profile in our online management system, and send prospective clients a link to the assessment form that has a ticky-box list of potential issues. I’ll review that before an intake session. Once a first session schedule is set, we’re off to the races.

The advantage of almost fifteen years doing this is that by now I have a well-practiced introduction. I’ll greet the client warmly, make sure I’m pronouncing unfamiliar names correctly, and welcome them into the conversational space whether it be in-person or virtual. I like to ask right up front whether they’ve done any kind of counselling or talk therapy before; their answer determines how much of the spiel I’ll need to give on the general therapeutic process.

If they’ve never done talk therapy before, I’ll keep it light and simple, and describe the collaborative process: them sharing as much or as little as they feel comfortable with, especially given the awkwardness of talking to a stranger, then me offering back what I think I’m hearing to make sure I understand what I can about their current situation and maybe a little about where they’re hoping to get to through therapy. I’ll describe how I use that to determine at least a starting point for whether I have a useful skillset for the work they want to do, so in the moment I might be able to offer some perspective or suggestions for potential work we might be able to do together. I suggest that depending on how much information the client wants to share in the initial session, I may or may not be able to get to that point of offering reflections, but I should at least be able to get a feeling of whether I’ll be a useful tool for them or not.

I will talk a little bit about how I work therapeutically, about my background training and the general approaches I take, but only if the client seems familiar or interested in hearing that upfront. I will explicitly offer to talk in more detail about what I can do, in the context of the conversation as it unfolds. My biggest concern is that I don’t overburden the conversation with a lot of details that might not be relevant to the work the client wants to do. I do, however, invite questions at any and every step of the process. I describe how I definitely invite a 2-way conversational approach; therapy often works best as a collaborative effort. I may bring the clinical perspective and experience to the table, but the client is always not only the Subject Matter Expert in their own experiences, but they are the “boots on the ground” field-testing and reporting back on any change processes we explore in session. I try to avoid positioning myself as The Authority; especially as a therapist, I’m much more comfortable in the role of co-author.

And perhaps most importantly, I tell the client that I don’t consider first sessions like this to be an indication of commitment on the client’s part; especially at Bliss, our admins like to ask new clients to book 2-3 sessions in advance just so they get time on our calendars (some of us tend to book up quickly and fairly far ahead). People who are new to therapy may feel like that ties them to us and obligates them to continue with a therapist they’ve only just met. I prefer to reassure them that I’m treating a first meeting like a test drive, so the client can get a feel for the process and my style; if they don’t feel like they can be comfortable with me, I’m going to wind up spending more time dealing with their resistance to me than with the issues they want to work on. So if I’m not the right partner for those conversations, I would rather help them find someone who will be.

I will tell them both at the beginning and end of the session to take a few days, a week, whatever they need to let the dust settle after the first conversation–especially if it’s been an emotional experience for them–and THEN think about how the conversation went, before making any decisions about working with me or not. I want my clients to be in the best headspace they can be in to make a choice like that. We don’t often get the same opportunity to be so deliberate in choosing who we work with in support of physical or mental health. I want to drive home the idea that the client always has the right to say NO in this work, including saying NO to working with a specific therapist.

My preamble done, then I yield the floor to them. I ask the client to tell me a little about themselves, the glossy-brochure bio details of who they are, general family or work details, any interests or hobbies or passions they have. This starts to give me an idea of the major players and influences in their lives as a whole, and background to the issues bringing them into my office. It’s the front door into the conversation about where the client themselves locates their current challenges. And at this point, I’m drinking from the firehose.

As I describe it to clients, at this point I am collecting every piece of information I can, because I don’t yet know what will be relevant and what will not. I ask a LOT of questions here, sometimes for clarification, sometimes to suss out whether I think a pattern is forming. I liken it to collecting children’s wooden letter blocks into a bag; at some point, I will upend the bag and put the blocks together to see what they might spell out. I’ll then toss that perspective out to the client to see what resonates or not. Things that resonate for the client, we stick to the mental wall as a “working theory,” a combination of what they have experienced and what I suggest from the clinical perspective as potential explanations or reframing. I’ll use these later to help me determine what tools might be useful in the context of what the client wants to change.

I may or may not do what I call the Family of Origin Snapshot, a quick relational genogram of their earliest influences and role models if it seems relevant. For example, FoO information is enormously valuable to me if the client is struggling with value conflicts, internalized narratives and self-judgments, or issues that feel like they’ve been around since childhood. (A genogram structure can also be an extremely useful tool for clients dealing with work stress, but in that case, I usually just refer to their literal Org Chart.)

And then, or somewhere in the deluge of information that is a first session, I ask my Magic Question: What does “better” look like? This is where the work begins. This is North Star by which we will set the work’s navigational compass, the point on the other side of the gap. When I do check-ins with the client down the road, the answer to this question is what we use to determine congruence in the work we’re doing: are we actually moving towards “better”, or have we come adrift of that defined goal? (The goal can change over time, but that’s not something we’re typically going to worry about in the first session.)

If I have time, this is the point where I talk about clinical approaches, what I bring to the table, and what I can offer in collaboration with those stated goals. If I don’t think I have the right tools for something that’s beyond my scope, I’ll make that very clear and offer some ideas for things I think MIGHT work that the client could look into, or assistance with referrals if necessary. But if the issues are in my wheelhouse, here is where I talk about the work I think I can help with, looking at attachment issues, stress and burnout coping strategies, internal narratives and other intrusive fiends, relational communications, intimacy issues (to name a few things in which I have been known to dabble).

There’s a lot of compassion and empathy on tap in that first session. Clients rarely come to us when things are going well in their lives, so respecting and reflecting on their challenges and struggles has to be a part of that space we create at the outset. I am a big fan of Carl Roger’s unconditional positive regard. I also try to pick out and mirror back some of the client’s own strengths, especially if they seem like they’ve become detached from them; that’s a callback to my days doing Solution-focused Brief Therapy; I try to give the clients back a sense of something positive in themselves on that first meeting. Reminding them they have strength never hurts, even if therapy isn’t something they decide they’re ready for, or I’m not the therapist they want to work with.

As we wrap up the initial conversation, I give them a chance to collect themselves if it’s been a rollercoaster first session, and we move things back to simpler, shallow waters talking about potential next steps (booking, billing, etc.). I will remind them they are under no obligation to return. I encourage them to take some time to reflect before they decide; like investing in a car, you want to make sure it not only has all the bells and whistles, but you want to ensure it has the drive handling and capacity you need. Therapy is an investment in ourselves, our health and wellbeing. We’re NOT stuck with whomever we draw in the lotto. And sometimes, making an active decision for themselves about who they will or won’t be vulnerable with, is the first self-empowering choice a client has been able to make for themselves–in a long time, or possibly ever. That idea alone deserves some mad respect.

Then I walk them out, let them know they’re welcome back on my schedule any time they’re ready, and offer them a warm goodbye. And I will always be delighted when they choose to come back and get into the work with me.

Mental Health, Therapy General

A regular meeting with one of my students this morning got us looking at two different types of therapist approaches to meeting and getting to work with clients. Both are valid methods of navigating intake and the early stages of information collection, and good to have in the therapist’s toolbox. It might also help clients understand why they click better with some therapists than others, and help them define what they’re looking for if they’re currently shopping for a therapist.

Most of the time people come into therapy because they are dealing with a specific problem, or experiencing a specific set of symptoms even if they don’t yet understand why. During an intake process, they’re meeting the therapist for the first time, which means two things are happening simultaneously:

  • Stranger meets stranger
  • Information changes hands

Establishing Rapport

Many people think of therapy in much the same way as they think of medical doctors: they have a problem, they go tell the professional, the professional gives them something to fix the problem, and hooray they’re cured! (Or at least feeling better.) This is historically the medical model for feeling better, and sometimes leads people to wonder why they can’t get a fix in the same ten minutes it takes a doctor to diagnose a set of patient-reported symptoms. Talk therapy doesn’t always work like that, but some models, like Short-term Solution-focused Therapy, do aim for a similar kind of immediate relief of at least the symptomatic distress.

Therapists are trained to understand what clients come to learn with experience: that perhaps the biggest factor in therapeutic “success” is the rapport established between the client and the therapist. That rapport is all about the relationship these individuals create through the process of sharing space, information, and (hopefully) empathy. Some folks don’t want to take the time to build a relationship, they just want the fastest resolution to their current discomforts so they can go on with their lives. Some people will only allow themselves to open up about experiences once they have established a degree of trust and safety with a therapist. This leads us to approach the work with our clients through either a Problem-centric focus or a Person-centric one.

Problem-centric Focus

This morning I was reflecting with my student on how they are developing their own clinical approaches, drawing on various learning resources through their training. They currently have an intake form they use to guide the first few client conversations that is very focused on gathering information about the problem: the symptoms, their perceived severity and persistence, the level of impairment the client experiences because of them. Only after digging into the details of the problem does the form expand into more general information about the client themselves.

This kind of approach puts the PROBLEM(s) front and centre and focuses the ensuing conversations on those pertinent details. This is a really useful approach if the therapist has only a limited number of sessions (or a one-off situation, as with a walk-in clinic), and needs to understand “where does it hurt the most?” or “where is the client seeking the most relief?” It’s also an effective approach with clients who are focused on fast resolutions and strategies rather than long-term self-development. Reflecting after this morning’s supervisory meeting it occurred to me that this is also probably a useful approach for student and novice therapists who need to determine as early as possible whether the client’s presenting issues are within the therapist’s limited clinical experience and scope of practice.

On the downside, it also presents a bit of a sandtrap to therapists operating from a “just fix it” mindset. The temptation is to label and categorize the problem without digging much into context or broader influencing features in order to go straight to symptom management… and in doing so, perhaps miss a lot of important information about influences on the client’s broader condition. In short: you’ve mitigated the symptoms but potentially done nothing to address or even acknowledge the actual problem.

Person-centric Focus

My own approach to those first client conversations is to get to know a little bit about the client themselves. I’ll ask if they have any previous therapy experience, or what they think therapy as an experience entails. I’ll ask them to tell me a little bit about themselves and tell them a bit about myself in return, though I generally weave any kind of detailed descriptions of how I work into the conversations about their challenges. Especially with people new to psychotherapy, I have less risk of getting lost in trying to describe clinical interventions to someone who has zero idea WTF I’m talking about, no context for what I’m bringing to the table. So I leave that until I can find ways of showing how I might apply what I know directly to their own issues, and let the contextualization do the heavy lifting for us both. I get a good sense this way of how the client talks and how they listen, what kind of language they respond to, and I have a chance to watch and mirror some of their body language (even in virtual meetings). If I can get a basic sense of them in the first few minutes, THEN I’ll ask what’s bringing them in to talk to “someone like me.”

I’m not a doctor; I’m not trying to bulldoze 25 clients a day through my office in ten-minute increments or less; I can take my time and get to know who’s sitting in front of me. (It also helps that I’m personally someone who loves drinking from the information firehose. I often describe my process in those first couple of sessions as gathering all the seemingly random bits of information the client chooses to share, and all the information they don’t even realize they’re sharing via word choices, speech patterns, and body language. I collect it all and sort it out as we go, pairing the client’s information with my observations and clinical experience to come up with working theories I can pitch to a client to see what resonates, and what makes them feel like I’m understanding what they’re sharing.

This type of approach puts the PERSON first and foremost and helps orient the therapist towards the person having difficult experiences before digging into the issues themselves. Focusing on the person is also useful when the client is in emotional distress, if the therapist can use mirrored body language and vocal tones to calm or counterbalance the way the client’s body or voice shifts as they get worked up. It’s not that we ignore the issues so much as we establish that rapport first, a person-to-person connection to put the client more at ease. It helps create some sense of safety (hopefully) for the client to talk about hard things, and to receive compassion and input from the therapist. It’s a style of approach that very much invites the Person into the room, not just the Problem.

The Person-focus approach has its own traps. It’s easy to misread clients who really just want solutions and strategies, if they’re genial enough to engage in the “getting to know you” patter, and in doing so, leave them feeling like you’re not serious, not taking them seriously, or taking to long to get to what they came for. Focus on rapport-building is often a slippery slope for therapists falling into their own biases and risking over-association or over-sympathizing with the client; this is a space in which we run a high risk of transference and countertransference occurring between client and therapist as we try to establish connection and empathy without always having good boundaries right up front.

Not every client is going into a first session with a clear idea of what they want or need from the conversation they’re about to have. Inexperienced clients generally can’t describe what they want from a therapist, other than, “Fix me so I feel better”–the same request they’d make to a mechanic to fix their car so it runs better, or to a doctor so they can feel physically better. Therapists have to develop almost a sixth sense for what live performers call “reading the room”: the ability to suss out a client’s level of (dis)comfort with talking about their issues and asking for guidance or help. Are they here for a quick strategy session, or are they here to unburden for the very first time a lifetime’s worth of relational chaos? (I haven’t yet figured out how to teach reading the room as a therapeutic skillset. It’s just a thing many of us do semi-intuitively.) But once we have that sense we can choose the most effective approach out of the toolbox, and off we go to the races.

Mental Health

[Part 1 of this post is here.]

I made the mistake of Googling “How to recover from burnout.”

Seriously, don’t do it. No, really, I —
Well, okay. Don’t say I didn’t warn you.

Now that you’ve done what I did and maybe scrolled through some of the amazing tripe that’s out there as advice, lemme tell you: ignore 98% of it.

One of the reasons I no longer practice something called “Solution-focused Brief Therapy” (SFBT) in spite of it being a highly-touted, evidence-based therapeutic intervention, is because it is at best a bandage solution, meant to deal quickly and (IMO) superficially with potentially significant client issues… all for the purpose of returning them to the workforce as Productive Members of Society as fast as possible, thus minimizing impact to the EMPLOYERS and their INSURERS. I’m not going to call it a scam outright, because it does provide some real, albeit temporary, relief to those who seek it. But it’s not an approach I respect for the simple reason that it’s predominantly used to tape up psychic injuries and send internally-wounded folks often right back into the very teeth of the stressors that are grinding them down in the first place.

And you know what that leads to? Burnout. Bandaids ain’t gonna hold jack-shit when we’re talking about the psychological equivalent of disembowelment. (Why yes, I *DO* have Very Strong Opinions on this topic, why do you ask??)

Workplace burnout is fast becoming the primary reason why employees take stress leave, even though what is likely covered by their insurance (assuming they have the luxury of coverage in the first place) is far below what’s actually required for recovery. From an American Institute of Stress 2022 study:

Workplace stress is one of the largest hurdles you can experience on the job. Stress at work comes in all shapes and sizes, across all types of industries and careers. After extensive research, our data analysis team concluded:

  • 83% of US workers suffer from work-related stress, with 25% saying their job is the number one stressor in their lives.
  • About one million Americans miss work each day because of stress.
  • 76% of US workers report that workplace stress affects their personal relationships.
  • Depression-induced absenteeism costs US businesses $51 billion a year, as well as an additional $26 billion in treatment costs.
  • Middle-aged participants had a 27% increase in the belief that their financial status would be affected by stress in the 2010s compared to the 1990s.
  • More than 50% of workers are not engaged at work as a result of stress, leading to a loss of productivity.
  • Companies spend around 75% of a worker’s annual salary to cover lost productivity or to replace workers.
  • The main causes of workplace stress are workload (39% of workers), interpersonal issues (31%), juggling work and personal life (19%), and job security (6%).

That’s a pretty bleak picture, and I suspect the Canadian numbers correlate relatively closely. Under Canadian employment law, “if you are a full-time employee with a work week of 37.5 hours, you earn sick leave at the rate of 9.375 hours each month for which you receive 75 hours pay. Sick leave is prorated if you are a part-time employee.” Under the Ontario Employment Standards Act, “Most employees have the right to take up to three days of unpaid job-protected leave each calendar year due to a personal illness, injury or medical emergency. This is known as sick leave.” Good to see in print that even our federal and provincial governance can’t agree on how to effectively manage sick leave, which is what employees are requesting when they are asking for stress leave. THREE DAYS??? Oy.

Unsurprisingly, many people start with the same assumptions about a stress leave that they might take into a vacation break: it’s time away from work, I’ll feel so invigorated, I’ll get so many non-work projects accomplished, I’ll make such great use of my now-free time! I’ll find a new job! But even a couple of weeks into a leave, they find they often Just Can’t Even, and that’s when they often wind up in my office, or offices like mine. They’re wondering where their motivation went, and why can’t they seem to feel any better even with the time they’ve already taken off.

Burnout is a state that affects us on every level: physically, emotionally, mentally, and relationally. That means recovering from burnout needs targeted recovery processes (note the multiple there) aimed at each and every one of those aspects. And because burnout is often the product of long exposure to the stressORS that have ground us down to mush, it operates very much like a long-term illness. We’ve been “sick” for a very long time, even if we didn’t realize it until that sickness brought our functionality to a crashing, crushing halt. Ergo, we’re not going to “fix” it with a weekend of sleep, a two-week vacation, or even a two-month stress leave. We just can’t. THAT’S NOT HOW BURNOUT WORKS. (And yet, that’s what employers and insurers want us to believe because it benefits them, or they believe it does, to have their employees back in the trenches as fast as possible, recovered or not. They want the bandaids, because then they don’t have to fix their own destructive, systemic issues that create the stressors in the first place.)

So then, how DOES one recover from burnout, if at all??

The first step is recognizing the difference between the stressors, and the stress. Stress is what you experience as a result of a variety of factors (the stressors) having an ugly, corrosive impact on your quality of life.

Stressors are what activate the stress response in your body. They can be anything you see, hear, smell, touch, taste, or imagine could do you harm. There are external stressors: work, money, family, time, cultural norms and expectations, experiences of discrimination, and so on. And there are less tangible, internal stressors: self-criticism, body image, identity, memories, and The Future. In different ways and to different degrees, all of these things may be interpreted by your body as potential threats.
Stress is the neurological and physiological shift that happens in your body when you encounter one of these threats. It’s an evolutionarily adaptive response that helps us cope with things […] [I]t activates a generic “stress response,” a cascade of neurological and hormonal activity that initiates physiological changes to help you survive[.] Your entire body and mind change in response to the perceived threat.”
(Nagoski & Nagoski, “Burnout: The Secret to Unlocking the Stress Cycle,” Ballantine Books, 2019)

Burnout, therefore, is the result of living within the cascading effects of that threat-response pattern over the long term. And as a long-term issue, the recovery is also going to be a long-term process. How long? Well, that depends on too many factors to have a standard formula, but from my perspective, what I’m seeing is that the deeper the burnout, the longer the recovery will take.

I have come to liken what’s actually required for recovery as being akin to what happens when a serious athlete, like a marathon runner, breaks a leg.

At the point of the break, the marathoner does NOT think, “Hey! Now I can go and run all those OTHER races I’ve been meaning to get to for months/years!” No, the marathoner is going to be KEENLY aware of the damage and the pain… something burnout victims are notoriously bad at acknowledging (something, something, frogs in pots of slowly-heating water, something…). In a best-case scenario, the marathoner can get off the course and into help and safety immediately. Sometimes the break happens and the marathoner is going to have to continue on for a while before escape to treatment can happen, which means the pain will be inescapable once realized, and the damage might get worse before it has a chance to get better. Obviously, we want systems that support the former, but all too often we’re trapped in systems that enforce the latter.

Once the marathoner is off the course, then we’re into a healing process that looks a lot like this, and this model is what I’m now using with my burnout clients:

  1. First things first, the break needs a chance to actually heal: knitting bone and soft tissue back together, sometimes with professional intervention, but mostly just letting the brain and body do what they need to do to put broken pieces back together. THERE IS ABSOLUTELY ZERO LOAD-BEARING ACTIVITY AT THIS POINT. There can’t be; the broken bones won’t tolerate it. There’s a lot of rest. This stage usually takes several weeks for both bone breaks and for burnout.
  2. Then, once the bone has knit and the soft-tissue damage or inflammation has largely receded, THEN AND ONLY THEN will a doctor give the okay to start physiotherapy and rehabilitation. This is the stage in which the marathoner is trying to teach new tissue how to do basic things like move and flex, and integrate with the existing tissue. Agin, not a lot of load-bearing activity here. In burnout terms, this is the stage in which people start to do basic functions in their own lives, like tend to personal care or basic relational interactions. They might start THINKING about whether or not to update their resume, but they’re generally in no great energetic state to put their best selves forward in interviews. This stage can take literally MONTHS for both the marathoner and the burnout client.
  3. After that, and only once the medical and phsyio supports sign off, can the marathoner even THINK about starting to move like normal. They’re certainly not in a state to go back to running, but they might be able to take a walk to the end of the block and back. They’ll eventually work up to making it a sloppy shuffling runwalk, and be constantly monitoring the new tissue for pain or other signs of damage. THIS is also a stage that can take months to progress through, and this is the stage where both athletes and burnouts are likely to push too hard too fast, and experience inevitable setbacks when the recovery process proves unequal to the desire to just get on with things.
  4. When there’s a generally-consistent ABSENCE OF SYMPTOMS related the break/burnout for period of time approved by the support system (NOT the recovering individual), THEN AND ONLY THEN is the individual at the state where they can BEGIN to start retraining their body to work back up to a level of pre-break functional capacity. This is NOT the stage at which the marathoner goes and runs a 26-mile race. This is when they start actually running to see how far they can get, or they start for endurance but take it at a quarter-speed. This is when the burnout client MIGHT return to work one or two days a week on light duty.
  5. From there we collectively eyeball a “return to full-function” target but maintain a consistent and careful watch on how the recovering individual does with resumption of the load-bearing factors.

Throughout this, the burnout client, like the marathoner, is hopefully working on adaptive skills to better balance the stressors that created the state of collapse in the first place. This may involve being honest with themselves about what they can and can’t handle; this may involve needing to do different work on managing stressful relationships. This may require changing jobs, or dealing differently with health issues. Some of these factors CANNOT be addressed by quick-fix bandaid solutions, and the entire recovery process is NOT a short-term affair. Burnout can literally take YEARS to recover fully; that part is defined mostly by the client’s ability to adopt and sustain more effective capacity-management strategies, not just “coping” strategies.

Clients don’t like hearing that they could be recovering from burnout for a long time; most people don’t like the notion of being compromised, because it will mean having to change how they live, how they behave, and how they view their own capability, differently for the duration. Employers don’t want to hear that they may be paying full or partial salaries for absent employees for months on end, and insurers put out so many hoops and challenges to those applying for stress leave that it makes it hard to onside medical and mental health professionals who are required to provide corroborating evidence of the client’s mental state for the duration.

I get it. It’s hard. So is being laid up with a broken leg when you’d rather be out running the Boston Marathon or through-hiking the Appalachian Trail. But the point at which you’re willing to acknowledge that something is broken is NOT the point to simply switch gears/stressors and keep applying load to something that has been broken down by bearing too MUCH load for too long.

Heal first. Then start to retrain or add adaptive skills. THEN start to work back up to load-bearing functionality. THEN re-assess that capacity, and make whatever changes will be necessary to maintain yourself at non-breaking levels.

It’s a slow process, but so far, it’s the only one I have seen work, and I’ve been looking at the issues of burnout for a really, really long time.

Mental Health, Uncategorized

In 2019 (when I started the original draft of this post), the World Health Organization released an updated classification for burnout as an “occupational phenomenon”:

28 MAY 2019 – Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition.

It is described in the chapter: ‘Factors influencing health status or contact with health services’ — which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.

Burn-out is defined in ICD-11 as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • feelings of energy depletion or exhaustion;
  • increased mental distance from one?s job, or feelings of negativism or cynicism related to one’s job; and
  • reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

Burn-out was also included in ICD-10, in the same category as in ICD-11, but the definition is now more detailed.

The World Health Organization is about to embark on the development of evidence-based guidelines on mental well-being in the workplace.

This blog has looked at the issues of burnout many times before (here, here, here). On a personal as well as a professional level–across TWO career fields, no less–I am intimately familiar with what WHO somewhat blithely labels as “chronic workplace stress that has not been successfully managed”.

On one hand, I applaud WHO for putting their eyes on this issue as their attention can have repercussions on a global level. On the other hand, when North American culture seems hell-bent on stripping everyone but the richest of their rights, it means the workload of making things function as the entitled expect, continues to be the only kind of trickle-down effect to land on the common worker. And at the end of the day, people who fear for their jobs are increasingly UNLIKELY to raise concerns and issues about stressors in the workplace that affect their engagement and efficiency, as well as their overall mental health and safety.

This isn’t an issue I know how to solve. Especially since I left IT, this is a discussion I have had with a very great many of my clients who work in IT specifically. This runs the gamut from trench-level workers in support call centres to the content developers (programmers/testers/designers/writers) to system architects, team leads, managers and corporate braintrust-level employees, to HR agents and executives, to C-Suite bosses. Burnout is pervasive in the high-tech industry at levels I have never seen from any other field, with the possible exception of teachers. Stress-induced sick leaves are rampant in IT, judging by my own clientele in two practices, and what I know of the types of clients coming to see many of my colleagues.

Burnout, as “chronic workplace stress that has not been successfully managed” means that several issues are coming to a head in the workplace:

  • unrealistic performance expectations (individual or across the corporate board)
  • demands and pressures that exceed regular working hours and bleed across employees’ private lives
  • artificial pressure to advance and/or transfer around the company for a breadth of experience or “to avoid stagnation” (Google in particular is notoriously heinous for this practice) regardless of the individual’s preference or capacity
  • lacking or insufficient support for employee mental health and balance with life outside of work
  • HR solutions and EAPS that are constrained to get employees back to work as quickly as possible, which always ends up working in favour of the corporations, not the employees
  • corporate practices that reward employees for making sacrifices that then normalize the culture of sacrifice

Organizations like WHO can legitimize the workplace effects of unmanaged stress, but this does nothing in truth to change the sales and management styles of businesses intent of maximizing a profit line no matter how badly they chew through human resources to do so. Looking at resources online dedicated to offering suggestions on retaining talent, I see some common themes:

1. Start with recruiting “the right people” who will “stay the course” (read: “people who won’t complain about getting hired for a 40hr work week who are then regularly asked to work 80+hr weeks).

2. Pay them well, offer bonuses and a good benefits package (read: if you give them enough money, they’ll theoretically never notice they’re missing their children’s childhoods, or their own romantic partnerships, or even sleep).

3. Offer them opportunities for advancement (read: because nothing makes people work harder than giving them goals that they can burn themselves out trying to achieve for the reward of yet more work and stress and burnout…).

4. Flexible work schedules, and a great corporate culture (read: give them all the comforts of home so they don’t miss actually going home quite so much). — edit to add: we did see an enormous shift downward in stress levels for much of the workforce who adapted to working from home during the pandemic, many of whom are not reacting well to corporate pressures to return to the office even part-time as of mid-to-late-2022.

5. Offer praise and affirmation (read: pleasant words on the way to self-sacrifice as a reward for setting oneself on fire make EVERYTHING SO MUCH BETTER, YO).

Okay, so I admit the bias here is exceptionally cynical, but I come by it honestly. These were cultures in which *I* came of age, and these are corporate practices I now watch consume my friends and clients and loved ones on a daily basis. But can anyone else spot what’s missing from these kinds of lists? When we talk about retaining good employees, can you see the glaring hole where the best answers of all should be?

Where in the conversation regarding burnout and retention are the discussions about governance responsibilities? Where is “more effective project/product management” that avoids the common practice of overselling features that cannot effectively be designed, developed, tested, documented, packaged and deployed in a realistic timeframe? Where is the discussion about mitigating the profit craving so that we reduce the factors that produce burnout in the first place, and avoid paying stress leave in favour of making it easier for employees to stay happily at their jobs? Where is the improvement in management that better controls customer-driven scope-creep under project deadlines?

In FantasyLand, for the most part. That’s where. And more and more people are “coming down with” symptoms of stress, fatigue, anhedonia; comorbid diagnoses of depression and anxiety increase exponentially in my clientele every year, even before the pandemic sent those numbers spiralling out into chaos. People take insufficient downtime through the work weeks because they feel they can’t repent of their busy-ness, and when they do take time off as vacation or stress leave, they rarely do what’s needed to recover (more on that in Part 2). Part of recovering from burnout across the board is going to require the corporate culture that engenders the stress to begin with, to take a long, hard look at its own culpability, and step up to change expectations and management styles. That isn’t going to happen in my lifetime, I suspect; stress is built into the very nature of a build-and-deploy, feast-or-famine cycle of software development.

So if we cannot remove or significantly redesign the stressORS, how then do we begin to reframe our understanding of healing from the stress itself? For that, we go to Part 2 of this discussion. Please stand by! 🙂

Current Events, Life Transitions, Mental Health

So there we were, six months into a pandemic, trying to pretend the world was getting back to “normal” in spite of COVID numbers slowly creeping back up in the wrong direction, a race war brewing, backlash against militarized and violent policing growing, an American election fiasco in the making, questionable political decisions on our own side of the border…

No, wait. Not “were”. ARE. Here we *ARE*.

Today in Ontario, many schools reopened their doors to returning students without a clear plan on how to manage classrooms under pandemic conditions. Parents, teachers, and school staff alike have been dreading this moment since things closed down in March; next to actual lockdown adjustment crises, that’s been the second or third most common issues walking into my (virtual) office for the last month or so. Even for those of us without kids but with an excellent understanding of science basics, there’s a sense of a timer ticking, and this year it’s not just about the surge of the usual colds and health issues that come from children playing together as children do. It’s all the OTHER infection vectors that are now in play.

And yes, we’re concerned. We’re concerned about how best to continue to support our clients and our communities while keeping ourselves, our colleagues and office staff, our offices, and yes, our clients and everyone to whom YOU are connected, as safe as we can. We’re still being advised by our governing colleges to avoid returning to in-person sessions for the foreseeable future, so virtual meetings continue. Six months into things, we’re still not back to normal operations, nor will we be any time soon.

Our clients continue to be graciously understanding for the most part, but they’re as frustrated as we are. We’re still helping folkx navigate a world where jobs are still disappearing as businesses falter, where pandemic/lockdown fatigue and social distancing remain considerable barriers to mental health, where “Zoom fatigue” and the normalization of working from home creates a whole new set of challenges to work/life balance routines. We’re trying to figure out how best to help our seasonally-affected clients prepare for the autumn and winter in the absence of most of their normal social options. And we’re trying our best to make sure we as therapists don’t succumb to this tidal bore ourselves.

All of which to say, six months on, we’re still here, still working, still doing our best to support where we can, validate and commiserate where we can, change what we can, offer what hope and perspective we can… And we know that some days, many days even, will be harder than others. We can’t make any of this go any faster, we can’t predict what life will look like in The After, and we don’t always know what will make it easier to get from Here to There either. But we’re in the mud with everyone else, and we get it.

Stay strong, stay safe. As the clich? says, especially at this point, “The only way out is THROUGH.”

Current Events, Mental Health, Practice News

So, here’s another truth about being a therapist at this particular moment in human history (last week’s behind the curtain view was a humorous one; this one’s a little more serious). Most therapists work from what’s called a “trauma-informed” perspective, meaning we are “treating a whole person, taking into account past trauma and the resulting coping mechanisms when attempting to understand [current] behaviors and treat the patient.” We also take into account the differences between trauma as a disruptive event, and complex trauma, which is “a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape.”. In other words, we’re good at coming in when the client is ready to do the work of unpacking or changing the way past events have, or continue to disrupt their current life.

…AFTER THE FACT.

We sometimes get lucky enough to be available as someone is processing an event in progress, like working to escape an abusive relationship or dealing with a loved one as they are dying. But even in those circumstances, we’re on the outside of the experience looking inward, a stable neutral presence that can help anchor and support clients in distress.

Hard truth time: ain’t none of us trained to deal with global epidemics and crises on this scale AS THEY ARE HAPPENING and AS THEY ARE ALSO HUGELY IMPACTING *US*.

We sometimes get called in very soon or immediately after a crisis event happens, but we’re not usually enmeshed in it ourselves. Right now, however, we’re supporting our clients and colleagues (many of whom are themselves in identical unfamiliar circumstances) in working through virtual channels, working from home, dealing with children and partners underfoot all the time in quarantine… while dealing with exactly those same issues ourselves. As I wrote last week, we’re all in this together, but like medical health professionals, having been determined by the government to be “essential services” therapists are ALSO working long hours to make sure we keep our own shit under wraps enough to be an effective support for our clients right now.

I don’t tell you this to make us seem like superheroes, because I can assure, we’re still pretty human (see last week’s post for proof of that). I tell you this because there’s a need to understand that while we’re doing the best that we can, we’re really not trained for this, either. Many of us are cobbling together what we know of trauma care with what we know of working with high anxiety and (where appropriate) basic CBT tactics to hold the intrusive, fear-laden thoughts at bay. The problem is, when we’re living through an honest-to-god global pandemic, the actual worst-case fears and risks are both absolutely legitimate, and pretty terrible… and the clients aren’t the only ones seeing that. The therapists are living and breathing those concerns and fears right alongside you.

The definition of complex PTSD keeps coming back to me as I watch people adjust to the new normal, including a persistently-high state of stress/worry/concern/anxiety/fear about the what-ifs. When you’re living in a dangerous time, there isn’t any form of escape other than to just “live through it”, no matter how long it takes. And being in that persistent state over the longterm always exacts a toll; it’s not going to be the same for everyone, nor will it manifest in the same timeframe for everyone. But it’s there. And we have to take that into account when we’re dealing with ourselves and our clients, not just in the future and after the fact, but right now. Today. In this moment.

The best tool I’ve got right now is working with people to normalize and validate everything in their maelstrom of feelings; to shorten down their personal event horizons and look specifically, and exclusively, at what is in their power to do TODAY? What will make them feel better TODAY? It’s not that I don’t want to sustain a sense of hope for the future, but we have to keep hope in the context of daily-fluctuating uncertainty. We need to frame it in an understanding that our current heightened state of curve-flattening mitigation tactics will take WEEKS yet, if not MONTHS, to drop the infection rate back to near-zero (because as long as there IS a new-case reporting rate, we ALL remain at risk; that’s just how viral pandemics work). I’m watching friends and clients intellectualize that timetable, but the truth of what their lives will look like is barely just starting to take hold on an emotional level, especially knowing that the pandemic is only the trigger for an economic crisis of equally epic proportions to come. This kind of uncertainty really eats away at a person’s sense of grounding and control.

It eats away at ours, too. Trust me on that.

We’re in a high-stress, high-uncertainty scenario not of our own making and even less under our control. The odds of this crisis *creating* complex trauma responses for a large number of individuals is likely high, because it’s a longterm situation and it’s inescapable. The challenge for us as therapists is that we can’t wait for this scenario to be over before we’re needing to put boots on the ground and be effective. We can’t wait until we get ourselves clear of this scenario before we wade in to offer support to others. When I say, “we’re all in this together”, I mean it quite literally. As therapists, for once we are not apart from your crisis; we may have our own responses to what’s going on, but we are also up to our eyeballs in it. We’re as uncertain, as stressed, as anxious, as terrified, as exhausted as you may be.

And we’re still here. If you need us, we’re keeping the lights on for you as long as we can, and hopefully all the way through.

(Both my home office and Bliss Counselling are still open and seeing clients, BTW. We’re only doing virtual sessions via Zoom or phone for the duration, but WE ARE OPEN!)