Working with unwanted feelings

Published on March 15, 2021July 20, 2022 by kshanmuk

When I am feeling anxious, unhappy or generally lousy, I hate the idea of mindfully noticing these unwanted feelings. There is intense resistance to “sitting with” or accepting my emotions. During these low moments, I have zero understanding or time for my feelings. My only goal is to get rid of them. I imagine many others feel the same way. When it comes to our harsher feelings, they can be intense, and often cruel. These parts of our personality know exactly what to say to make us want to crumble.

I struggled for the longest time with Internal Family Systems therapy in telling me that my emotions, my critical voice, or my less healthier coping behaviours are not bad. IFS encourages that every part of us is welcome (to learn more about IFS and parts work, read this post). I struggled to accept this viewpoint when I felt every part of me was, in fact, not welcome. Parts of me could be a jerk some days, and there was no way I was going to cater to that nonsense. For those with anxiety, depression, or other mental health struggles, I’m sure you can relate to how badly you want to get rid of these unwanted feelings.

My own turning point

regal pan pizza on box — Photo by Creative Vix on Pexels.com

For me, my willingness to change my perspective came from recognizing that pushing away my unwanted feelings wasn’t actually getting rid of the pain. When I wanted to deny my urge to eat another slice of pizza, that part got louder. When I pretended I wasn’t feeling angry with my family, that part made sure it vented in my head. Wishing parts away rarely works in getting rid of the pain, or having them stay quiet.

It’s too hard

I get that it’s really hard to do therapy. It’s hard to sit with our emotions. It’s hard to create space for these distressing parts of our personalities to talk and voice their feelings. Can you imagine allowing those parts of you that are suicidal or have urges to self-harm to actually be given the space to talk? Understandably, there is fear in letting these voices have space because, what if it creates more distress, more extreme behaviours, or more danger?

I had these fears as well. I didn’t want to hear any of my anxieties. They were annoying and they would make me feel lousy all day. Who would sign up for that willingly? However, IFS teaches us a way to work with these parts of our personality safely so that they do not take over. There is a way to do the work carefully and slowly, so that other parts of your system do not get overwhelmed. We can continue to hear these parts of our personality, understand their fears and intents, build a better relationship with them, and negotiate for space or a shift in coping strategies.

There’s no way I can get better

Working with unwanted feelings. Kasi Shan Therapy: Kitchener ON, Online counselling. — Photo by Alex Green on Pexels.com

Sometimes, we’ve lived with these unwanted emotions and behaviours for years. Some of the clients I’ve seen have gone to various therapists and tried different coping strategies to help with their healing. Understandably, if they feel stuck, they are pretty certain this is an unchangeable and fixed part of their living experience. They are confident that nothing will help, and there’s scepticism that healing can happen.

I felt this way as well. For the longest time, I’d focused on traditional talk therapy, using modalities like CBT and DBT. These are incredible counselling approaches that work for many folks. Coping skills, working through exposure treatment, and recognizing unhelpful thinking patterns are effective for treating many struggles. However, when we focus on treating just our thoughts, we are forgetting the rest of our body. Our body, ironically, is what carries traumas.

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.
-Bessel van der kolk, “The body keeps the score”

You experience feelings throughout your body. Sure, you can challenge your thoughts, you can try new behaviours, you can learn ways to cope. But for many of us, this isn’t enough. Knowing how to do a thought record isn’t enough. We want our emotions to catch up to what we know. In order to do that, our therapy styles cannot just focus on thoughts, but has to include experiential change. This means constantly returning our awareness back to the body and the system to see how it is affected by these interventions. Healing involves taking the time to notice our physical sensations, and understand what these subtle cues are trying to communicate.

This is the only way I can survive

Sometimes it can feel scary to let go of our current coping mechanisms. If you know that the only way you can manage your challenging family is by having a few glasses of wine at the end of the day, it is going to feel incredibly hard to give that up. I have clients who are cautious of telling others about self-harming behaviours because they fear repercussion or worry they will be shamed into stopping. The thought of changing our patterns can prevent many of us from starting the work.

For anyone who has hesitated to reach out for help because of the need to stop a specific coping mechanism, please know that this does not have to be the case. My job is not to tell you to stop drinking. I understand that there is a part of you that feels drinking is the only way in which you can survive this current hardship. However, if we were able to explore the underlying fears related to your family, would you have to keep drinking? What are you actually protecting by drinking? If you were no longer feeling threatened by this fear, would you need to keep coping in this way? Drinking patterns, and other coping mechanisms, can slow down if underlying fears are addressed. Once your system no longer feels threatened, it no longer has to survive by turning to wine.

I don’t want to know

A common reason that I see clients hesitating to do trauma work is that it will involve looking at the past. One of our strongest survival mechanisms is denial. Going back to a painful period in time can feel like we’re asking for trouble. It hurts to revisit difficult memories. We may feel cautious of how we will see our loved ones after exploring what those memories mean and how they have impacted us.

With EMDR, IFS, or any other trauma-based treatment, the goal is not to discover a big, bad secret from the past. However, with trauma-based treatments, we can become aware of details that we’ve kept hidden from our conscious awareness. When these details come to light, we have options. Clients can chose to share these details with me, or they can keep this awareness inside. Clients can decide whether this knowledge requires intervention. There are options to bring in new coping mechanisms or more self-compassion. We can work towards understanding the impact of these moments and unburdening our system of these wounds. Finally, clients can chose to keep doing what they’re doing and pretend this awareness does not exist. There is no set agenda for how we move forward. We know the pain is there, and we shift to addressing this pain, only when you are okay to go there.

Reach out

Part of me was nervous about writing this article. I can talk nonchalantly about being a perfectionist, but acknowledging that I can also have messy feelings is hard. The fear of others’ judgements prevents us from reaching out (even though our system is desperate for help and relief). At the end of the day, hiding has not helped us feel better. Talking to a therapist who you feel is safe and effective is one way towards healing. If you have any experiences with the above battles and wish to talk, please don’t hesitate to reach out.

Warm regards,

Kasi

schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Feeling stuck in trauma, therapy. Internal family systems therapy

Why am I feeling stuck in my trauma?

Published on February 1, 2021July 20, 2022 by kshanmuk

Even years after a traumatic experience, we can feel stuck in a place of emotional distress. In therapy, I noticed that many trauma survivors would struggle to find self-compassion. They would get caught in an endless loop of self-blame and resentment. Other clients were keen to begin therapy; however, they were easily overwhelmed once they started to talk about the trauma. Many clients felt unable to deal with their past because their current coping mechanisms (e.g. self-harm, substance use) were causing so many problems.

These clients are intelligent, capable, and well-versed in therapy lingo. Many of the folks I see can recite CBT and mindfulness principles to me. Despite knowing how they “should” think or behave, they were still feeling stuck. As a clinician, learning Internal Family Systems therapy (IFS) transformed my counselling practice and helped me better understand these stuck points. I hope this blog post will help you recognize what may be affecting your own recovery.

Healing wounds

When it comes to trauma, we develop strong emotions and negative beliefs about ourselves. We carry these wounds with us, not always recognising the subtle ways in which they influence our behaviours and actions. For example, after a rape, a survivor could start to believe “I deserved this”, “I did something wrong”, or “I am unlovable”. She may feel an intense level of shame or fear. If she is carrying these beliefs and emotions, she will develop protective methods in order to adapt. These protective habits ensure that the beliefs and feelings stemming from the traumatic event are never experienced again.

A Parts-led System

Before we dive into the topic, let me give a brief explanation of Internal Family Systems Therapy. IFS recognizes that our mind is divided into sub-personalities; each “part” or personality can be active at different points in time. When I am calm, confident and feeling at peace, I feel like myself. However, there are times during the day when I get triggered and parts of my personality get activated. At work, the therapist-part of my personality likes to coach me in what I should say to clients. When I’m home, my mother-part can narrate all the ways I need to my take care of my child. My self-conscious part gets loud when I am shopping for a new pair of jeans. My over-achiever part can take over when I’m signing up for courses, agreeing to tasks, or managing my calendar.

Having our mind divided likes this is not the same as multiple personality disorder. We all have parts. At various points in time, these parts get triggered and feel the need to push a certain agenda (e.g. attending therapy, avoiding treatment).

Managerial Parts

In the IFS model, we recognize that there are two types of protective parts that develop following a trauma. The first type of protective parts are called managers. Managers are the parts of our personality that try and prevent bad things from happening. Managers are proactive in preventing us from feeling the same emotions that we experienced in the time of trauma. They try to ensure safety by keeping our environments and relationships in balance.

A sexual assault survivor may create one or many managerial parts to prevent an assault from happening again. Her managers will try to avoid triggers that bring about similar emotions and beliefs to her experiences following the trauma. For example, she may have a part that refuse to go anywhere by herself at night, a part that turns down dates, a part that numbs emotions, and a part that is fearful of strangers. All of these parts protect her from being vulnerable again.

How do managers affect therapy?

Managers can show up in a variety of ways in the therapy context. From their perspective, they are attempting to the help the client. Bear in mind that these reactions are not always within our awareness. These parts of our personality become triggered and react oftentimes outside of our conscious decision-making. These parts are not intentionally trying to cause harm, but using their own capacity and knowledge to keep us safe.

Before we can start processing trauma, my job is to work with these protective parts of your system. You have survived all these days by using these protective mechanisms. Unless every part of you is on board saying, “Yes! Let’s talk about this!”, it is perfectly natural for some type of blocking to show up.

Common manager blocks:

People-pleasing parts: This part tends to agree to all of the therapist’s comments despite not truly believing the therapist’s feedback. It may often accept a task or homework, despite knowing that other parts of the system are not ready to take on a certain challenge
Avoidant parts: This manager often misses appointments, or is late to therapy. In attempts to prevent the client from talking about a difficult experience or feeling vulnerable, this part can take over and avoid therapy all together.
Achievement-oriented parts: This part tries very hard to ensure that the client is doing his or her best. This part will often read therapy textbooks, learn about different diagnoses, and speak about trauma 24/7, if allowed. Unfortunately, the client can easy become overwhelmed or burned out if this part takes over all the time.
Critical parts: This part is often trying to be a cheerleader to the client; however, its words are harsh. The client can feel too distressed by the criticisms to work on the traumatic memory.
Denying parts: This part often minimises traumatic events in order to protect the client from truly recognising the impact of these horrific moments. Often these clients will say “it’s not a big deal”, or “that’s just normal at my house.”
Socially-avoidant parts: In fears of experiencing another distressing social encounter, this part will avoid any situations in which the client may stand out. This can prevent clients from spending time with friends, attending school, or dating. This socially avoidant part can also avoid situations where the client has to speak assertively or set boundaries.
Caretaker parts: This part will often forego the client’s own healing in order to take care of others. I often see this manager role in many postpartum parents as they learn to balance their own needs with that of their newborn child.
Intellectualising parts: This part will focus on analysing the situation, or thinking of the right answer versus allowing the client to sit with, or experience an emotion.

Firefighters

fireman standing near fire on building — Photo by Tobias Rehbein on Pexels.com

IFS explains that there is a second type of protective personalities that they refer to as firefighters. Whereas manager parts are in the role of preventative care, firefighter parts are reactive. They see a fire, and quickly work to put it out. In this way, firefighter parts are extremely helpful. Rather than letting the client feel burdened by traumatic wounds, firefighters are quick to find ways to stifle these intense feelings and beliefs.

Consider an example where an individual has recently been dumped. The impact of this breakup can be incredibly intense, worthy of hours of sadness, loneliness, and perhaps, hopelessness. This individual may also start to develop beliefs about himself following this experience, such as: “I don’t deserve love”, “I am ugly”, or “I am not good enough.” In reaction to this vulnerability, firefighters try to quickly eliminate these thoughts and emotions. They do this through any means, irrespective of other consequences that can arise. For example, this individual may have a part that is angry at his ex, a part that pushes others away when they talk about feelings, or a part that has him moving out of this neighbourhood.

Common Firefighter Blocks:

Feeling stuck in therapy. feeling stuck in trauma. IFS, internal family systems therapy — Photo by Alexander Krivitskiy on Pexels.com

Cancelling appointments parts: Following a difficult appointment, this part may feel it’s too vulnerable to return to therapy.
Angry parts: In response to feeling vulnerable, these parts want a way to feel empowered and lash out through anger, oftentimes projecting on to safe people.
Dissociative parts: These parts have the client “check out” during or after therapy. They can also cause clients to forget parts of traumatic experiences. Clients may present as distracted, or they have limited recollection of what happened.
Self-harm/Suicidal parts: In hopes of distraction or reducing pain, these parts practice self-harm or focus on suicidal urges.
Substance-dependent parts: In order to numb out emotions and thoughts, these parts turn to alcohol and drugs.
Food-dependent parts: These firefighters turn to food for comfort (e.g. binge eating, purging, excessive exercise). In hopes to feel some semblance of control, some firefighter parts focus on caloric restriction. Unfortunately, this food-dependent part tends to get push back from other parts of the system (e.g. parts that are ashamed in having to cope this way, part that resents being stuck in treatment because of food).
Body sensations/Illness: These parts can take over during sessions through headaches, body pains, upset stomachs, and other uncomfortable body cues. This can make it hard for the client to be fully present during the therapy experience.

Working with a Self-led System:

There is a common phrase in IFS, which is “all parts are welcome”. When it comes to therapy, every part of you is welcome to show up. Your therapist recognizes, like a family, you have various members in your internal system. As with families, each member has a different role, a different set of fears, and (sometimes) a different agenda. In IFS, we are not fearful of these managers and firefighters. Instead, your therapist will focus on the intentions of these parts to keep you safe. By taking the time to slowly work with these parts of your personality, your system begins to build more trust and there are fewer “stuck points”. It is at this point that we have permission to work on our underlying traumas.

IFS believes in the concept of “Self”. This is the true version of you. Not the one addled by anxieties and symptoms, but you at your very core. This is the confident, calm, curious, compassionate version of you that has been hidden due to firefighters, managers, and traumatised parts taking over. In IFS, we work to have a better relationship with our protective and traumatised parts so that there is more space for your true Self to come forward.

Parts-led versus Self-led

When we have a chaotic leader guiding us, our nation reacts with volatility. We become divided with one party screaming that their perspective matters most, and the other side counteracting with the same level of intensity. In similar ways, when our internal system is led by our managers, firefighters, or wounded parts, the rest of our system goes into a fight-or-flight mode. When we are led by Self, the system believes this leader has our best intentions at heart. There is more space to trust, listen, and negotiate.

When there is enough trust between Self and our protective layers, managers and firefighters can step back so that we work with the actual traumatic wounds. This process can take a session, or it can take a few months. The more vulnerable you felt during and after a traumatic experience, the more intensely your firefighters and managers will work to ensure these vulnerabilities are locked away safely. Therefore, therapy can take time in order to build trust with these protective parts of your personality.

Your therapist’s parts

The last piece that can create stuck points in therapy is your therapist. As your therapist is human, it is natural for him or her to also have managers, firefighters, and traumatised parts. In order to stay Self-led, I am regularly assessing whether my parts are interrupting the work in order to protect my own wounds. If a part of me reacts, then I am no longer feeling open-minded or curious. Instead, I am deterred by the agenda of my own anxieties.

If a therapist is triggered, this can impact a client from receiving effective and genuine support. Clients may feel that their therapists do not understand, and that they seem impatient or defensiveness. If this is the case, please know that this is not your fault. It may not be your therapist’s fault either, especially if he or she is unaware of these parts taking over.

Shifting away from feeling stuck

When we take the time to get to know our internal managers and firefighters, we build trust with these parts of our personality. We allow space for these parts to assess if it is safe to stop their protective roles. With this trust and safety, they no longer feel the need to react as strongly. We are finally able to move past these stuck points in healing.

If you are interested in learning more about IFS, or if you would like to discuss stuck points in therapy, please feel free to reach out.

Cheers,

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

What causes mental health struggles?

Published on January 18, 2021July 20, 2022 by kshanmuk

When new clients come in for counselling, many present with resentment and anger for experiencing mental health struggles. Following any emotional upheaval, we search for clarity. We want to understand what causes mental health difficulties, and we want the fastest solution to make it all feel better. Since mental health impacts the whole family, caregivers and parents are also brought into this practice of self-blame. Caregivers are often overwhelmed with frustration or guilt, and are keen to discover how they could have done “better”.

Finding a reason for what causes mental health struggles is a logical first step. We want clarity. We want an answer to help explain why we are doing what we are doing. Unfortunately, the truth behind what influences mental health struggles is complicated.

An Emotion-Focused Family Therapy Lens

What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.

Emotion-Focused Family Therapy provides a comprehensive framework that explains what factors influence mental health struggles. As you go through this framework, please bear in mind that you may experience several of these factors while also feeling at peace with your mental health. Alternatively, you may only experience one or two components, and struggle a lot. This is because there is no single equation that tells us which factors have to be involved for mental health struggles to show up. We are all unique. Therefore, our resiliency and vulnerability varies.

Genetics:

It is rare that a single gene causes mental health issues; however, our DNA does have some influence on our emotional well-being. Research has confirmed that there are genetic similarities to various mental health issues. For example, the Psychiatric Genomics Consortium found that individuals who have a diagnosis of autism, schizophrenia, bipolar disorder, depression or ADHD share certain DNA variations. The Consortium also presented research finding 30 positions in the DNA sequence that increase the risk of developing bipolar disorder. They have found 108 fixed positions on a chromosome for schizophrenia. So what does genetics mean for those who are struggling with mental health? It reinforces that this is one (unchangeable) factor that plays a role in increasing your vulnerability.

While our genetic codes are permanent structures, epigenetics is the ways in which our environment can influence how our genes are read. At any given point in time, our genes are turned “on and off” based on environmental factors. Difficult situations, like living through a war or a pandemic, can influence the ways in which our genes are read. There has to be the right combination of environmental stressors and genetic reading for a mental health disorder to form. What’s wonderful about epigentics is that, while we cannot change our genetic code, we can influence our environment so that we are less vulnerable.

Emotional Avoidance

When it comes to unpleasant emotions, a natural response is to avoid sitting with these distressing feelings. After all, who enjoys feeling sad or anxious? While we often try and push these emotions aside, in most situations, they come bursting out of the dam in the least convenient moments.

One significant factor that causes mental health struggles is our ability to process emotions. By avoiding our emotions, we tend to face more consequences in the long-term. For example, if you experience bullying at school, you may decide to avoid school all together. This works well in the short-term. However, how long can you keep this strategy going? If you do avoid school for months, what are the new consequences that you have in missing so many classes?

We emotionally avoid by using distractions and coping strategies. These strategies are often effective as quick-fixes, but rarely work to address the actual wound and sometimes create more problems. Common coping strategies include: exercising to work off anxiety, excessive drinking to avoid feeling sad, lashing out in anger when stressed, or emotionally eating to deal with loneliness

To stop relying on short-term solutions, we have to work at a safe pace to process and talk about our feelings. For example, we have to acknowledge our distress about being bullied, work through the anxiety of returning back to school, and talk with our parents and teachers about a safety plan. We can seek out therapy to learn how to to slow down our emotions, and work through the intensity of these feelings. Once these emotions no longer feel as overwhelming, there is less need to use coping strategies. We feel more empowered to address the emotion if it comes up again in the future.

The “Superfeeler” temperament

EFFT recognizes that 25% of the population has the “superfeeler” temperament. Consider a scenario where you are wearing a hearing aid that is turned up far too high. This hearing aid will pick up on nuances that others do not notice. Small noises can become highly distressing. This individual will likely be more reactive to noises, and feel overwhelmed by the amount of auditory input.

Similarly, superfeelers are like these highly-sensitive hearing aids. These individuals feel emotions intensely. They quickly pick up on others’ emotional cues and often experience the other person’s distress (e.g. think about a baby who automatically starts to cry when she/he sees another child crying). Like sensitive hearing aids, superfeelers are quicker to respond to emotions. Unfortunately, this can mean small events or arguments are seen as highly threatening.

black couple arguing with each other at home — Photo by Alex Green on Pexels.com

Because other people are not wearing these sensitive hearing aids, they are not picking up on the threats or cues that a superfeeler is noticing. While a superfeeler may feel upset about an event, their loved ones do not understand why this superfeeler is reacting so intensely to something that seems mundane. This can often lead to invalidation. Think back to a time when someone dismissed your feelings or called you over-sensitive. While this moment may still sting, this type of experience is common for a superfeeler.

There is a significant level of fatigue in having a superfeeler temperament. Because superfeelers are so attuned to emotions, they experience difficult feelings like shame, anger, or guilt that much more intensely than others. Understandably, there is a strong desire to lower the intensity of these feelings in any way or form. A lot of people with this type of temperament will cope by distracting themselves, avoiding situations, becoming quick to anger, feeling hopeless, numbing emotions, or sticking rigid rules in order to control an environment.

Social and Cultural Influences

What do you see in the media? How do your favourite celebrities and influencers act? What are the cultural expectations of “appropriate behaviours”? Social and cultural influences can play a pivotal role in making us feel more vulnerable. There is pressure to be a certain weight or look a certain way. There is the “right way” to express our emotions. More often than not, emotional avoidance is glorified. There is an insinuation that being independent is best, and that it is weak to need others for our emotional stability. Society and culture gives us inconsistent messages about our emotions, our appearance, and our behaviours. The “rule book” changes with time, and it’s a continuous race of trying to catch up. Mental health issues can rise in trying to meet these demands and feeling as if we are falling short.

Life stressors

broken heart love sad — Photo by burak kostak on Pexels.com

The most unique factor that causes mental health is life stressors. Life stressors can vary for each individual. It can include events such as bereavement, workplace stress, divorce, bullying, breakups, large transitions (e.g. moving, deployment), injury or illness. Our resiliency factors influence our ability to manage these events. Meaning, if our environment is secure and supportive (e.g. stable home, strong friendships, access to medicine and help), we are better able to recover or work through these stressors.

Life stressors becomes a concern when we feel ill-equipped to handle all of the demands that come with this stressful experience. We feel a sense of fatigue because our body is perpetually in a state of fight or flight. These are challenging events for us; therefore, it can be difficult to create safety and balance in light of these stressors.

Hormones

Whether it’s puberty, pregnancy, lactation, or menopause, we know that hormonal shifts can create vulnerabilities for our mood and mental health. Hormones act as communicators between various organs and glands in the body. We are always producing hormones to regulate our system. However, when our production levels are affected, our entire system responds.

Here are some ways that hormones may be influencing your mental health. When your insulin level is affected, there is a higher likelihood of poor concentration, fatigue, anxiety and panic. Oxytocin is connected with our sense of pleasure, belonging, and joy. When this hormone is imbalanced, people struggle with more symptoms of depression and sadness. Cortisol and adrenaline are both considered “stress hormones”. They are activated and produced by our body whenever we are in a stressful situation. Low levels of these stress hormones often shows up in individuals who are depressed and exhibit signs of emotional shut down. Alternatively, high levels of cortisol and adrenaline can lead to an individual feeling more irritable and panicky.

Family Environment

A lot of caregivers blame themselves for their children’s mental health. If the above sections do not convince you that there are a multitude of factors involved in mental health, please let me say it plainly. Caregivers are not at fault. You are one piece of the puzzle, and while your influence is important, you are not the cause of your loved one’s mental health.

man standing beside his wife teaching their child how to ride bicycle — Photo by Agung Pandit Wiguna on Pexels.com

Family environment can play an important role in shaping mental health issues. Consider the family rules about emotions and behaviours. What is seen as acceptable in your family? Some families are expressive, and accepting of a wide range of emotions. On the other hand, some families are incredibly uncomfortable with displays of affection, tears and tantrums, or “unhappy” feelings. In the situation of the latter, we become vulnerable to emotional avoidance. We may shut down, or keep our feelings bottled up in order to fit the family norms.

Parents and caregivers are usually the first form of attachment for an infant. Depending on how parents attend to their baby’s needs (be it avoidant, anxious or comforting), the child will pick up on these cues. If parents frequently hover or fret, their baby learns that he or she is not safe in the world and requires extra protection. This child may then present with anxious tendencies as he or she grows up. On the other hand, children of avoidant parents may learn that their emotions are not important and that relationships are not safe places to be vulnerable.

There is no simple cure
For what can never have a single cause.
-Aldous huxley

I get what causes mental health issues. What do I do about it?

crop black couple holding hands after reconciliation at home — Photo by Alex Green on Pexels.com

There are many ways to support the above needs. We know that attachment can change over time. If you find a secure and loving friendship where there is safety to express freely, you are more likely to start accepting your emotions. With help from friends, family or professionals, we can work on problem solving skills and gain support to address life stressors. We can learn to empathise with the superfeelers in our lives. Our healthcare providers can help us with hormonal changes to find better balance in our internal system. We can work on regulating our emotions using skills like emotional coaching and validation to shift us out of emotional avoidance. Mental health does not have to be a life sentence, but it does require some patience and effort. If you are struggling, please reach out.

If you are interested in Emotion-Focused Family therapy, please stay tuned for my Advanced Caregiving workshop. This two-day workshop is for caregivers (parents, spouses, grandparents, friends) to learn techniques to help their loved ones living with mental health struggles.

Take care,

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

5 Tips to help keep your New Year’s resolutions

Published on December 31, 2020August 17, 2022 by kshanmuk

As we welcome a new year, some of us may be considering the endless battle with New Year’s resolutions. About 80% of people abandon their resolutions within the first few months of starting. We know this is not due to will power, but because it is hard to create new habits and change old patterns. Moreover, the mere 20% of people who have accomplished New Year’s resolutions don’t necessarily feel happy or accomplished at the end of the year. Instead the resolutions have brought upon stress and pressure for months.

So how do we try and change habits and reduce the likelihood of failure? How do we do this without burning out? Here are a few strategies that can help.

1. Habit Formation

Think about the lack of effort it takes for you to drive your car, make a cup of coffee, or put on your makeup. These are tasks that require limited thought and effort today. However, consider the first time you ever learned these tasks. You went through endless hours of driver’s ed, botched up your first cup of coffee, and resembled a clown for many days until you got your makeup just right. The difficulty of mastering new skills are understood and accepted. This is the same empathy and patience I encourage you to keep with your New Year’s resolutions.

fresh hot coffee prepared with machine — Photo by Elle Hughes on Pexels.com

Whether your goal is to learn a new language, go to the gym more often, save money, or any other endeavour, it will require some effort at first. The consistency of practicing these skills is what will help you achieve success. You don’t have to think about the steps involved to brew a cup of coffee; the task is automatic. You repeat the same steps of getting up in the morning, shuffling over to your kitchen, and pouring in some coffee grinds over and over until the tasks became routine. Similarly, the more often you work on your New Year’s resolution in a consistent manner, the easier it will be for these patterns to become automatic. Consistency at the start is really important. I encourage working on a resolution at the same time of day, at the same location, and with the same steps.

With habituation, you don’t have to think about doing the task. It just becomes a part of your lifestyle: 6 AM is when you meditate, 4 PM is the time you practice Italian, and 7 PM is when you go for a run. These tasks may still require effort; however, the routine is set in place to increase success. You don’t think about it; you just do it.

2. Changing the All-or-Nothing perspective

new year's resolutions. how to keep your goals this year. — Photo by Pixabay on Pexels.com

One of the biggest factors that demotivate us from completing New Year’s resolutions is failure. When we’ve gone four days in a row of not smoking, it can be incredibly discouraging to break that flow with a cigarette on Day 5. However, addiction therapists can confirm that changing a long-term habit takes time and that relapses are normal. The American Cancer Society suggests that it will take, on average, 8-10 times of trying before an individual is able to finally be smoke-free for a year. If these individuals stopped after their first failed attempt, this level of success would never have been achieved.

Rather than seeing relapses as failure, we want to shift away from an all-or-nothing mindset. It is so easy to fall into a pit of shame and guilt when we have slip ups. However, relapses are incredibly helpful teaching opportunities. Each moment of relapses helps us learn about our vulnerabilities, and the patterns involved that made us go back to our old behaviours. We can learn and prepare for these moments.

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Depending on your new year’s resolutions, having a relapse may be an indicator that you may benefit from having a strong support team. This might involve connecting with supportive friends for feedback and encouragement as you try once again. Or, it may involve returning to treatment (e.g. connecting with your physician, therapist, dietitian, whomever is part of your treatment team).

The beauty of relapses is gaining the confidence that you can return back to trying this new habit after a setback. Just because you have a drink, smoke a cigarette, or ditch the gym does not mean this is your life sentence. Success comes with increased confidence to return back to the work in creating a better lifestyle.

3. Check your environment

We are all triggered and motivated by our environment. When there is chocolate sitting next to us, we are more likely to reach for the chocolate. If the bed feels warm and toasty in the morning, we are more likely to sleep in than get up. We want to create the ideal environment that increases the likelihood of maintaining positive behaviours, and reduces negative behaviours.

New Year's resolution. Changing Habits. Kasi Shan Therapy — Photo by Karolina Grabowska on Pexels.com

Let’s say your resolution is to save more money this year. The first step in achieving this goal is to consider what your usual patterns are when it comes to spending money. When are you more likely to spend? When are you more likely to save? Let’s assume that you’re most likely to spend money after going on social media during your lunch hour. What would happen if you turned off your social media at this vulnerable time? Alternatively, what if you’re more likely to save after seeing your bank account. If this is the case, how do you ensure that you have easy access to your bank statement? This may involve looking at your statement weekly, or having a screenshot right next to your computer.

Consider setting up some deterrents for the behaviours that you are looking to reduce. If you have a harder time accessing a bag of chips (e.g. it’s on a higher shelf), you are less likely to reach for it. In the same way, you want to have access to things that will help you maintain your new habits. For example, if you’d like to exercise in the morning, you can place your workout clothes next to the side of your bed. You can have your work out mat and dumbbells ready for you in the living room to start right away. By setting up your environment effectively, you’re able to shift your behaviours and increase the likelihood of fulfilling your resolutions.

4. Pair with a reward

New Year's resolution. Kasi Shan Therapy. Changing Habits. — Photo by Andrea Piacquadio on Pexels.com

New year’s resolutions are hard, and we cannot rely on will power alone. This is why it’s important to pair our goals with a reward. Until that automatic behaviour is formed, it’s helpful to have rewards paired together with a new habit. These rewards can be anything that you love and are already motivated by. For example, let’s say you love tea. If your resolution is to meditate daily, pair this habit with the practice of drinking tea following your meditation. If this favourite tea can only be enjoyed after meditation, you are more likely to be motivated to follow through on the task. Another example is pairing exercise with watching TV or listening to your favourite podcast. You’re more likely to go for that run in order to catch up on some episodes.

5. Plan for the hard days

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I don’t want you to get caught up in thinking of the worst case scenarios, or to focus on failure. However, it’s helpful to acknowledge our vulnerabilities. I know that, after an especially long day, I love watching terrible TV and eating all the carbs in my house. Normally, I’m fine with this and accept it as part of my self-care. However, if my New Year’s resolution involves healthier eating, I’m going to have to plan ahead for those tough days. This involves stepping back to consider how I want to manage in alternative ways. I will have to problem solve others options for self-care (e.g. reading, crafting, taking a bath). I can also ensure that I have healthier snacks available that satisfy my love for savoury foods. What will make you more likely to fall back on old patterns? What are alternative ways to handle this situation?

A Word of Caution

Truthfully, I am cautious about New Year’s resolutions. Some people love the idea of a fresh start to practice healthier habits. However, it’s important to recognize if following new year’s resolutions will actually exacerbate mental health struggles. Be kind and honest with yourself. If you struggle with body image, for example, then adding a resolution like increasing exercise, losing weight, or eating healthy may actually increase frustration, guilt, or inadequacy (especially when we know that setbacks are normal!) Rather than adding unnecessary stress, focus instead on some of the above strategies without a time frame or measurable markers of success. You don’t need these markers to deter you from making positive changes. It’s a lot easier to manage a goal of reading more often by just picking up a book. You don’t need to read a certain number of books within a certain time frame to pursue this new interest.

New year's resolution. Changing habits. Kasi Shan Therapy: Counselling online and in Kitchener, ON — Photo by Oleg Zaicev on Pexels.com

Let me know if your new year’s resolutions stick this time, or if you need support in working with these habits. I’d love to hear.

I hope 2021 brings you much happiness, comfort and good mental health!

Best wishes,

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

8 Tips to improve sleep troubles

Published on December 13, 2020August 17, 2022 by kshanmuk1 Comment

When it comes to falling asleep, there are many people who can easily pass out as soon as their heads hits the pillow. This post is not for them. For the rest of the population, please know that it is normal to have sleep troubles at some point in your life. Some of us find that these issues resolve after a few days. However, others may struggle for a long time with poor sleep quality.

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Often, what exacerbates our sleep is conditional arousal. Think of Pavlov’s dogs; they learned to salivate as soon as they heard a bell ringing because they were consistently provided food at the time of the bell. Even when food was taken away, they automatically started to salivate as soon as they heard that familiar noise. Similarly, we’ve learned to associate anxiety and restlessness with our bed. We start to anticipate that we will have poor sleep even before we climbed under covers. We stress that it will be another night of tossing and turning. Unfortunately, these expectations cause too much distress to fall asleep.

Luckily, there are ways in which we can create a better sleep pattern. Today’s post is all about simple behavioural changes that you can use to improve your sleep.

Behavioural Changes to Improve Sleep Patterns

1. Go to sleep when you’re sleepy

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Before you scoff at this point, I want you to consider when you go to sleep. Do you go to bed at a specific hour in hopes that you will be rested enough for the following day? Are you heading to bed when your body feels exhausted? Is your mind still whirling away at this time? If you answered yes to the above questions, this strategy may shift you out of current sleep troubles.

One of the best ways to reduce sleep issues is to recognize when we’re genuinely sleepy. Our “ideal” time for bed is when we can barely keep our eyes open. It’s when you cannot concentrate on your show or book, and are nodding off on the couch. It is at this state of fatigue that you will likely fall asleep when you go to bed. Prior to this time, while you’re body may be exhausted, your brain is still not ready to shut down. Therefore, if you typically go to bed at 10 PM, but you’re not drifting off until closer to midnight, then it’s best to wait until midnight before heading to bed (Don’t worry! There are other strategies to help bump your bedtime to a more ideal hour).

2. Get up at a consistent time

When you make changes to your sleep patterns, your body is working hard to shift its circadian rhythm (your internal 24-hour clock that tells you when to be awake or asleep). Your internal clock gets thrown off with insomnia. Getting up at a consistent hour helps your body regulate, and establish a routine of its awake and rest times. Unfortunately, many of us sleep in on weekends. While we force our system to get up at 6 AM on weekdays, we stay in bed until 2 PM on weekends. This creates more confusion to your circadian rhythm. Chances are that you will not be tired for 10 PM on Sunday night. You end up falling back into the same pattern of sleep disruption and fatigue for the rest of the week as you try and shift back to an earlier bedtime.

3. Do not use the bed when you’re awake

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I encourage clients to only use their bed for sleep or sex. It’s easy to get sucked into patterns of reading, eating, watching TV, or talking on the phone while in bed. However, when there are sleep struggles, we want to eliminate all connections of being alert while using our bed. Again, think about Pavlov’s dogs, and training your minds to associate bed with rest.

Most days, it will take approximately 20 minutes to fall asleep. If it takes you longer, or if you start to feel anxious within the first few minutes of lying down, the best option is to get out of bed. I know this sucks, and I encourage you to do whatever low-key activity will help you stay in good spirits at 3 A.M. This means watching TV (try not to choose something that you’ll feel compelled to binge watch), reading, tidying up, etc. Try to return back to bed in about 30 minutes, or whenever you start to feel sleepy.

Another consideration is getting up when you’re awake at 5 AM versus staying in bed. While your bed is likely cozy and inviting, by lying awake in bed during these early hours, you’re unintentionally reinforcing the message that it’s okay to be alert in bed.

4. Middle of the night wake ups

It is normal for us to have several awake moments during the night. We go through several rounds of REM (rapid eye movement) and N-REM (non-rapid eye movement) sleep cycles, which can typically last 90 to 120 minutes. Usually, we have short moments of being awake during the first phase of NREM sleep. For most of us, we don’t process these occurrences and usually fall back to sleep without any trouble (e.g. think about those times when you vaguely recall fluffing your pillow, turning over, and drifting off to sleep again). Vulnerabilities like conditional arousal can make us more cautious about being awake in the middle of the night. If anxiety kicks in when you have these wakeful moments, it can prevent you from easily falling back to sleep. If elaboration strategies are not enough to help you fall asleep in a few minutes, it’s best to get out of bed, do a low key activity, and try again in 30 minutes.

5. Get rid of naps

woman sleeping on sofa with throw pillows — Photo by Andrea Piacquadio on Pexels.com

Getting out of bed every time you are anxious or unable to fall asleep, and consistently getting up at an early hour will be exhausting. Chances are you’ll experience several sluggish days at the start of your new sleep routine. This is normal, and in fact, a good thing. After a few days of being in this zombie-mode, your body will feel so tired that you’ll start to feel sleepy earlier in the night (thereby bumping your midnight bedtime slowly back up to your ideal hour).

What often prevents people from getting to the above stage is due to naps. Your body is ready to fall asleep at night time, but if you take a rest during the middle of day, your circadian rhythm is getting confused once again. In order for this to work, stay out of bed during the daytime. It’s okay for you to go to bed at 8 PM during the first week if that is when sleep starts to encroach. It will take a few weeks before your circadian rhythm is regulated.

6. Create a bedtime routine

We teach young children about bedtime by using a simple routine at the end of the day. This involves activities like taking a bath, completing toiletries, putting on pyjamas and then reading a story before turning off the lights. When this pattern is followed daily, a child gets used to winding down by the end of this routine.

Unfortunately, we drop all pretences of having a bedtime routine when we become adults. Fair enough; you’re an adult and don’t require being tucked in. However, creating a simple routine (approximately 20 minutes) that you follow daily can help your body learn to settle down prior to bed. Some simple activities to include into your routine are:

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Having a cup of decaf tea
Stretching
Playing a low-key game (e.g. crosswords, candy crush)
Toiletries
Taking a bath
Doing the dishes
Prepping lunch
Listening to a podcast

The point is that these activities are not so riveting that they’ll hold your attention for a long time. Because the entire process takes approximately 20 minutes, and because it’s repeated daily, your system will learn to adjust to this new pattern.

7. Check your environment

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What kind of distractions are readily available in your room? You know yourself better than anyone else. This means recognising your vulnerabilities and habits. If you can easily spend hours on Instagram at the end of the night, chances are that having the phone next to your bed can make you more susceptible to staying awake.

Another common distraction is the alarm clock. If you tend to obsess about the time (e.g. “It’s 3:00 AM and I’m not asleep yet…. it’s 3:10 AM and I’m not asleep yet… it’s 3:20 AM and I’m not asleep yet.”), then this device is actually causing more harm than good. Turn the clock so it is facing away from you. Set your alarm for the next day so that you can trust the option of waking up on time without having to check the time constantly.

Assess whether your bedroom is truly a comfortable place for sleep. Making small changes like setting a cool temperature and adding dark curtains to reduce light can make a significant impact for sleep troubles.

8. Review your daily activities:

What you do during the day impacts your quality of sleep. Consider the effectiveness of when you work out, play video games, eat large meals, etc. For example, many individuals feel more alert after working out. If you fall under this category, you want to ensure that your work out is done earlier in the day.

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What kinds of foods and beverages have you consumed? If you are experiencing sleep troubles, your best option is to cut out caffeine by midday. Consider the types of food you had for dinner. Digestive issues can make it really hard to feel comfortable when you get into bed. If you struggle with digestion, especially at night, consider speaking with your doctor or a dietitian for feedback about what foods to restrict.

While having a glass of wine at night is a treat, research has also shown us that having too much alcohol reduces your quality of sleep. You’re more likely to fall asleep due to the sedative qualities of alcohol, but chances are you’ll be awake in the middle of the night.

What if none of these strategies get rid of my sleep troubles?

If your sleep issues are caused by more complicated factors like anxiety or trauma, more intensive treatment is recommended. In these circumstances, we can incorporate various therapeutic modalities like EMDR or cognitive-behaviour therapy for Insomnia (CBT-I) to address your unique needs.

Let me know if any of the above tips worked for you!

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

5 Tips to help your mental health during the second wave

Published on November 29, 2020August 18, 2022 by kshanmuk

As the number of COVID-19 cases rise in the Kitchener-Waterloo region, the possibility of heading into another lock down becomes increasingly likely. This isn’t an easy time. We all miss our families, friends, activities, and having the freedom to do things without restrictions of physical distancing. However, none of us have a magic wand to make this change happen today, and my realist brain tells me to prepare. And so, today’s post will include tips to help your mental health during this phase of this pandemic.

What can I do for my mental health?

1. Figure out your basic needs

Maslow's Hierarchy of Needs. Copyright: TeacherPrintables.
Kasi Shan Therapy: 5 tips to help your mental health during the second wave, COVID19.

Maslow’s Hierarchy of Needs (a theory about human motivation) explains that it is important to meet the foundational needs of physiology and safety before being able to truly focus on our psychological needs (belonging, self-esteem, and self-actualization). This means creating a plan for ensuring you have proper access to meet your physiological needs (e.g. water, food, shelter) and your safety needs (e.g. finances, employment, health, law and order).

What does this mean practically? It means creating a plan with your family to ensure you’ll have food and water if you need to go into quarantine. You may have to speak with your landlord about rent subsidies if you are unable to go to work during this time. Your basic needs also includes financial stability. You may have to speak with your employer to know your employment and financial eligibility rights. Visit the Government of Canada‘s page to see the various financial services available during this pandemic. When it comes to your health, review the recommendations from public health about following current best practices to stay safe.

2. Create a schedule

Kasi Shan Therapy: Mental health during COVID19. — Photo by Bich Tran on Pexels.com

Having a predictable routine and plan for the day brings great comfort. While there is so much happening in the world that we cannot control, you do have some ability to create a daily schedule that works for you. It helps to know when you intend to wake up, what hours you’d like to work, when you’ll be eating meals, and when you get to clock out for the evening. While creating a plan for your activities, I recommend ensuring that the following are added:

Fun/new activities: Let’s face it. Being stuck at home can get pretty monotonous. Ensuring that you are trying out novel activities or fun hobbies helps break up the pattern, and gives you somethings to look forward to during the week.

Set a routine time for sleeping: Sleep struggles have escalated during this pandemic, which is no surprise when we are suddenly taken out of the practice of our usual 9-5 work hours. It’s easy to ignore the alarm when it goes off in the morning, or to spend endless hours watching TV at night because we can sleep in. Lack of sleep will start to play a toll on your mental health after some time. You’ll notice you’re more irritable, you may start snacking more frequently or you just feel a constant level of fatigue. Create a bedtime routine to help your body and mind learn to wind down before bed. If your sleep schedule is completely out of sorts, try and go to bed and wake up at roughly the same time daily (this includes weekends).

Make time for exercise. Exercise works as effectively as a low-dose antidepressant. Getting consistency in your level of exercise (ideally a minimum of 3x per week) will help regulate your emotions. There are a lot of free online resources right now if you are not a fan of working out or are unsure how to start.

3. Talk about your feelings

I’m totally biased in preaching this message. We tend to stifle our emotions, and let’s face it, no one is doing great right now. What’s the point in pretending we’re doing okay, when compassion and understanding goes so much further in helping us heal? Find safe people to talk to about how you’re doing. This may include friends and family, or it may involve a mental health professional. We are often caught in a culture where it’s not okay to be vulnerable. However, the best way to increase the strength of a relationship is in voicing our feelings. It gives the other person a chance to validate your concerns, and also acknowledge their own.

There was a study conducted in the UK at the start of this pandemic where people were asked about their level of loneliness. Within matter of days during the first lock down, the numbers jumped from 1 in 10 to 1 in 4 people voicing they were lonely (learn more at Mental Health Foundations). By reaching out to others and sharing your worries, you create the opportunity to build connection with new friends.

4. Plan for the bad days

I know that sounds super pessimistic, but let’s not kid ourselves, everyone will have moments of suffering during this pandemic. When it comes to our mental health, the easiest option would be to problem solve our worries. We don’t get this option with COVID-19. So, while we wait this pandemic out, it’s useful to have a plan on how we get through difficult days.

Every person is different when it comes to interests and skills, so I encourage you to think of what options you would like to have in your coping plan. Some helpful options include using mindfulness or distress tolerance skills. It’s helpful to have four or five different tasks as part of a coping plan. These are tasks that will help you get through this moment, and may even help your emotions calm down a bit. They will not get rid of the issue all together, but it will get you through the moment of suffering without creating further distress. For me, my favourite coping skills are exercise, reading, watching sitcoms (or really, anything light-hearted) and eating junk food.

5. Find a balance between positive events and accomplishments

One of my favourite lessons from dialectical-behaviour therapy is that we feel better when we create a balance of accumulating positive events and building mastery. When it comes to “accumulating positives, this is basically a fancy way of saying focus on those activities that make you feel good (e.g. taking a long bath, staying in PJs and watching reality TV, going on vacation, etc). Having these positive activities makes us feel great and keeps us in good spirit.

However, we start to find these tasks mundane when we don’t they are not balanced out with work. Consider how awesome it would be to go away to a spa or resort. The first few days, or even weeks would be relaxing and lovely. How would it feel for you after a month or even a year though? I imagine you’d get bored, or this type of activity becomes less exciting or pleasurable because it’s so habitual. It’s not that we wouldn’t appreciate the vacation on it’s own, but the work makes us feel more appreciative of this down time.

This is where building mastery comes in to the picture. Building mastery can mean two things. The first way to build mastery is by working through tasks on your to do list. These may be tasks that are mundane (e.g. doing dishes, folding laundry, spring cleaning) or overwhelming (e.g. applying for a job, creating a budget, completing paperwork). These tasks are often ignored, and we tend to procrastinate about getting them done. Once these tasks are are completed, there is a sense of relief and perhaps even pride. By working through your To Do list, you start to feel more in control of your world. There’s no longer that looming pressure, and you feel more confident with your ability to manage life.

The second way to build mastery is through short-term or long-term goals. When we think of the pandemic, we have months to spend at home. What would you like to achieve during this time that will help you feel proud and accomplished? These tasks are much longer, and will often require several steps along the way to eventually get to the end goal. The goal itself may be challenging, but it should be broken down into manageable steps so that you can work in smaller steps to grow your skill and knowledge. Again, this is very individualistic, and your goals will depend on your own interest and needs. Take a moment to consider what you would like to master, and the steps you would need to take in order to achieve this goal.

What will you do for your mental health?

I hope you are able to incorporate one or more of these tips to support your mental health. Did one in particular work well for you? Were there ones you didn’t like as much? Let me know!
Your mental health matters. If you are needing some support during this time, please feel free to reach out.

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Postpartum OCD: The Curse of Never-Ending Scary Thoughts

Published on November 15, 2020July 20, 2022 by kshanmuk

While postpartum depression and anxiety have become more widely-understood, there is still limited research about postpartum obsessive-compulsive disorder. This mental health struggles occurs in approximately 1-10% of parents. Since postpartum OCD presents as excessive worrying and helplessness, it is commonly misdiagnosed as anxiety, or worse, it is dismissed as “normal worrying”.

person washing his hand — Photo by Burst on Pexels.com

When you think of OCD, your mind may jump to stereotypical examples like excessive hand washing due to a fear of germs. With postpartum-OCD, parents are often struggling with scary thoughts regarding the safety and well-being of their baby. As a forewarning, some of the examples shared below can be triggering. Please read with caution, and reach out if needing support.

The first element of OCD: Obsessions

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There are two key components that make up OCD. The first is obsessions. Obsessions involves intrusive and distressing thoughts, images, or beliefs that continue to repeat incessantly. Individuals struggling with obsessions do not feel in control of these thoughts, and are quickly overwhelmed. Common OCD obsessions include:

needing order or symmetry
fear of harming yourself or other people
unwanted sexual thoughts
religious obsessions (e.g. fear of offending God)
fear of limited or lack of control (e.g. acting on impulsive urges to shoplift)

Common obsessions with Postpartum OCD:

crop mom dressing newborn on bed — Photo by Polina Tankilevitch on Pexels.com

Contamination fears (e.g. bottles not being cleaned thoroughly)
Fear that baby will get sick or die (e.g. sudden infant death syndrome, car accidents)
Sexually intrusive thoughts (e.g. what if I am turned on when changing my baby’s diaper?)
Concerns about hurting the baby. For example:
- What if I drop the baby and her head cracks open?
- Intrusive thoughts about stabbing/shaking the baby
- Image of drowning baby in bathtub
- Urge to scream at baby
Concerns that others may harm the baby
Stress about making the wrong decisions (e.g. feeding the wrong food)
Rigidity to schedules/routine (e.g. nap times, feed times)

The second element of OCD: Compulsions

An individual with OCD is aware that these obsessions are not valid or logical. However, because the images or thoughts are so distressing, it feels important to get rid of them quickly. This is how compulsive behaviours start. When an obsession becomes too much to handle, compulsive behaviours are used to manage them. If you’re scared of germs, you start to wash your hands. If you’re scared of your baby dying during sleep, you may need to check repeatedly during the night to ensure safety. These compulsions are not effective in actually eliminating or addressing the fear; however, they provide a quick fix in that moment. Because the intrusive thought comes back quickly, the compulsive behaviour is repeated in order to help the individual calm down.

Common Compulsions with Postpartum OCD

When it comes to postpartum OCD, these parents are overwhelmed by the idea of harming their baby or being unable to protect their baby. Compulsive behaviours involve any means in which to offer their baby protection. Examples include:

man tattooed praying — Photo by Ric Rodrigues on Pexels.com

Avoidance of the baby
Checking repeatedly to see if bottles/supplies are clean
Excessive-reassurance seeking from health care professionals to confirm that baby is safe and healthy
Removing all sharp objects from the home
Avoiding any news or media related to child abuse (due to fear of being turned on)
Refusing to give baby a bath
Refusing to change diapers (due to fear of sexually abusing baby)
Avoiding breast feeding or eating certain foods to prevent contamination
Excessive praying
Isolating baby from loved ones
Not driving in the car with baby

Some compulsive behaviours seem normal. After all, double checking that the bottles are clean, or peeping in to the nursery to ensure your infant is asleep are perfectly normal tasks that all parents practice. The concern with compulsions is when these behaviours are done repeatedly. When intrusive thoughts are too distressing and compulsions take up a large chunk of time, our quality of life starts to suffer.

The commonality of intrusive thoughts

Most of us, irrespective of having a mental health diagnoses, will have disturbing thoughts from time to time. In fact, intrusive thoughts happen to approximately 80% of new parents. We’ll have a fleeting thought about falling off a balcony, driving into oncoming traffic, or yelling at our family members. When we are not fraught with distress and fatigue, we can usually shake our heads and call it for what it is: a strange thought. We may scoff and think it’s odd, but we don’t put too much thought into it, and can move on. For those with postpartum OCD, intrusive thoughts are so distressing that these parents assume there is some truth or meaning to these obsessions. Rather than shaking their head and saying “what a weird thing to think”, they become overwhelmed with guilt and shame at ever considering these thoughts.

Fears in reaching out

In a previous post, I had talked about some of the barriers that prevent parents from seeking help. One of the biggest blocks in reaching out for help is the fear that expressing these intrusive thoughts will lead to a call to the Children’s Aid Society. For those who struggle with this fear, I would like to reassure you that having a scary thought does not mean you are going to act on them! Parents with postpartum OCD have the best intentions for their children. They are overwhelmed by the fear of causing any harm that they are willing to practice whatever forms of compulsive behaviours to avoid this potential issue. Seeking help does not mean a call to the authorities.

postpartum OCD and anxious thoughts — Photo by Mr. Beanbum on Pexels.com

Postpartum OCD is not a “mom’s issue”; it can also be experienced by dads, adopted parents, and other caregivers. If you or a loved one is experiencing intrusive thoughts during the postpartum months, please do not stay silent. Postpartum mental health is treatable. If you are concerned about your own symptoms, but are not ready to talk, you can fill out the Yale-Brown Obsessive-Compulsive Scale to complete a self-assessment.

Take care,

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Disenfranchised grief: What to do when others do not recognize your grief.

Disenfranchised Grief: When no one seems to understand your loss

Published on October 25, 2020August 17, 2022 by kshanmuk1 Comment

I’ve been talking to many individuals lately who have experienced ectopic pregnancies, chemical pregnancies, and complicated deliveries. During all of these conversations, I noticed a theme of disenfranchised grief. Disenfranchised grief refers to “the types of loss that are not so readily recognised or supported by society.” Grief therapist Lisa Zoll explains that this type of grief happens in one of three ways: 1) the relationship is not recognised, 2) the loss is not recognised, or 3) the griever’s right to grieve is not recognised.

disenfranchised grief: What is it, and tips to support. — Photo by Pixabay on Pexels.com

When it comes to the death of a partner or child, society can empathize. It’s clear: there once was a person, and now this person is no longer here. However, when situations are not as clear-cut, it’s as if others don’t understand how to support us. Our grief experience is real and intense; yet, it feels we’re not entitled to our sadness and distress. There is little acknowledgement or validation of our experiences.

Examples of disenfranchised grief:

Grieving someone you didn’t like or who did not treat you well. There are many confusing emotions when our abusive partner or parent passes away. In this moment, it is so important to recognize dialectical thinking. We can be relieved that we are no longer experiencing abuse AND grieve the loss of this person. With complicated relationships like these ones, there are many questions that will be left unanswered (e.g. Why did you do this?) There is also the finality of circumstances, which prevents us from ever repairing this relationship. It’s very easy in this phase to get caught up in “what if” questions.

Parents who have experienced difficult child birth experiences (e.g. NICU visits, unplanned C-sections). Friends and family can feel confused by the grief experienced when a baby comes home, but parents are still caught in a state of mourning. These parents have had many components of their pregnancy and postpartum care taken from them. They have lost weeks of blissful pregnancy. They have had days or hours taken away from them as they watch their baby in the NICU uncertain when they will be able to leave safely. It feels like there is no closure or resolution to the sense of panic despite having left the hospital. These parents can experience difficulties with attachment to their little one, or low self-confidence in their parenting because they are caught in that moment of loss.

The loss of a partner from an extramarital affair/taboo relationship. Grief is grief, irrespective of how the relationship formed. When we lose someone we love, it hurts. Because affairs are taboo in our society, publicly mourning the loss of this partner is met with less support or compassion. Similarly, individuals who are not ready or able to identify openly as LGBTQ (+) can experience disenfranchised grief when mourning the end of relationship. If these individuals have not informed others about their sexual orientation, there is no space or safety to grieve the end of a relationship.

Our loved one has not passed away, but is no longer available to us. This can occur for a variety of different reasons such as: divorce, moving away, family conflict, mental health, etc. In these moments, grieving individuals are often given dismissive feedback such as :”You’re better off with him”, “It’s a normal part of life, why are you so upset?” or “I would be so angry if I were in your shoes.”

Our loved one has passed away due to suicide, overdose, or some form of mental health struggles (e.g. complications from eating disorders). Unfortunately, because the circumstances surrounding these deaths are complicated and often stigmatised, community members may not know how to address the grief. This can often lead support people to avoid the topic, or worse, avoid grievers in order to prevent an “awkward” conversation.

Reproductive loss: e.g. chemical pregnancies, miscarriages, still births, elective abortions. Parents can experience a variety of emotions when facing the struggles of reproduction. Miscarriages are so common, occurring in approximately 1/4 pregnancies. Infertility issues happen in approximately 1/6 couples. These individuals are on a roller coaster of hope and grief with each attempt in reproduction.
Becoming a parent. By transitioning into this new stage of life, old friendships may fade. There is less time for our former hobbies and interests. A solid night’s rest is no longer guaranteed. Body shapes and sizes may fluctuate following delivery. When others come to visit, we are more likely to receive positive feedback about the baby. However, there is limited discussion and less acceptance about a parent’s sadness in adjusting to this new lifestyle.

The grief has happened a long time ago: Somehow, a metric was created that classified grief as “complicated bereavement” after 6-12 months from the date of a loved one’s passing. This metric suggests that after a year, the grief should have become integrated into your life. While it’s okay to be sad about the death, it’s not considered “normal” to feel grief as intensely.

What can I do?

Recognise that your symptoms are in relation to the grief. Grief can vary for each individual. It may show up as anger, avoidance, endless tears, guilt, emotional numbing, or other forms of expression. Allowing yourself to accept that you are grieving helps you shift away from dismissing your own experiences. Your loss is real and valid.

There is no time line for grief. You do not have to be okay after 12 months. This loss meant a lot to you. It had a significant impact in your life. Why should you feel at peace after a year? That doesn’t mean you will not adapt, or that there is anything wrong if you feel better after a year. We all process and cope differently. It is not a race, there is no magic formula that will tell us how quickly we’ll be “over it.”

Let go of the pressure to “get over it”. You can decide if or when you want to talk about the grief. Writer and psychotherapist Megan Devine has a beautiful framework she uses with grief called “the vomit metric.” Whenever you feel the pressure “to move forward” from the grief, think about how intensely the thought makes you want to vomit. For example, if thinking about decluttering your child’s room 4 years after they have passed away makes you want to vomit, it means you’re not ready. This is okay! Again, it’s helpful to shift away from focusing on what we “should do” by accepting what we are ready to do. Whenever you feel motivated to declutter, that is the best time.

Find like-minded people. While your immediate social circle may not understand the ins and outs of this grief, there may be others who are struggling with similar grief. Sign up, whether it is via an informal facebook group or a formal support group, to connect with others who are sharing these experiences. Examples of support groups include: Pregnancy and Infant Loss Network, Family and Caregiver Support (for those whose loved ones have mental health diagnoses), and Divorce Care Recovery.
Consider how you want life to look like today. You may not be ready to think of a five year plan just yet. However, when you consider your readiness and your current distress, what would you like to do today? What are you able to manage? What can you push for, and when do you need to stop? Every day will vary, and this is normal.

Create a ritual that works for you. Give yourself the opportunity to remember your loss on a regular interval (if you want to). This may involve writing a letter to your unborn baby on the day of her birth. You may chose to journal regularly whenever the grief is at its peak. Perhaps you send a financial contribution to the mental health organization of your choice on specific anniversaries. Alternatively, you may decide to stay in your pyjamas, take the day off work, and allow yourself to cry and reminisce about your loved one on the day of his passing. There is no right or wrong way to do this ritual. It truly depends on what feels most natural and comforting for you.

If and when you’re ready, speak up. Talk about the loss as much as you need to with your support system. Do this when you are at a place of patience, as many of your friends and family will likely botch up in knowing what to say. If you have the patience for it, guide them in what you need from them. Be clear when certain comments are not helpful. None of these people will make the pain or sadness go away; however, there is incredible power that comes with knowing you are cared for.

Every social system is different. Some individuals experience grief, and are met with support and empathy by friends and family. I hope this is the case for you. However, if you are struggling with loss and finding yourself isolated, please reach out. There is no right way or right time to work through these emotions. When you want to work through the grief, please know that there are a variety of options to support you in processing these feelings, such as journaling, support groups, or individual-counselling.

Kasi

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Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Five Ways to Challenge Negative Thoughts

Published on October 12, 2020August 18, 2022 by kshanmuk

After writing my last post about common anxieties during the postpartum period, I wanted to provide some strategies to help challenge these negative thoughts. Irrespective of whether you have a mental health diagnosis or not, it’s easy to fall into unhealthy thinking styles when you feel vulnerable. I hope these five strategies can help you refute negative thoughts and shift into a calmer frame of mind.

1. Finding Evidence

Cognitive-behaviour therapy uses the term hot thought (a.k.a. “automatic thoughts”) to refer to thoughts that pop into our mind after we are triggered. These hot thoughts are often mean, disheartening and self-deprecating. They often express a vulnerable belief we have about ourselves or the world. For example, if you have had a difficult conversation with your partner, a hot thought might be: “My partner is going to leave me” or “My partner is sick of me.”

Because these thoughts make us feel fragile, it is easy to fall into an emotional spiral rather than address the truth of these statements. This is where the strategy of finding evidence for and evidence against a hot thought can be helpful. There is a part of you that truly believes this critical thought to be true. Rather than pretending this part doesn’t exist, it’s more helpful to consider its perspective (don’t worry, we don’t stop the exercise at this step). Write down every fact (statements that are objectively true) that helps argue the validity of this negative thought. For example, if your hot thought is “I’m a crappy student”, then your evidence might include: a poor test score, a lower grade on your report card, your friends’ grades, or difficulty grasping teaching material.

5 ways to challenge negative thought patterns. Kasi Shan Therapy: Counselling support in Kitchener, ON — Photo by August de Richelieu on Pexels.com

Now, pretend you are in a court trial. In order to fairly assess your hot thought, you need to also consider counter arguments. This involves spending time looking at every evidence that refutes this negative thought. It is when we start assessing this counter argument where most of us recognize the fallacies in our hot thoughts. For the most part, our negative thoughts come from a place of emotional reasoning, rather than actual evidence. When we are forced to identify the evidence (or lack thereof) behind our thinking, it becomes clear fairly quickly that our hot thoughts are not valid.

Example of hot thought: “I’m a crappy student.”

Evidence For

Evidence Against

– I did poorly on my last test
– I didn’t get an A on my report card
– My friends have higher marks than me
– I didn’t understand the last lesson

– I have a B average on my report card. I am meeting the expectations.
– It takes me a bit of time to review material on my own before I understand a concept fully
– There are some kids who are getting higher grades than me, and there are some kids who are getting lower grades than me
– This is not my strongest subject, but I am doing well in other classes/activities
– When I study with my friend, I’m able to see where I understand and don’t understand concepts fully. This has helped me get better grades in the past.
– I am able to ask the teacher questions if I don’t understand the material
– I take notes in class, do my homework and try my best.

2. Checking for Double-Standards

When it comes to giving advice or offering feedback to others, we are usually gently and generous. However, when the same problem happens to us, we become the meanest critics. When we have negative thinking patterns, it’s important to step back and consider how would we talk to a friend in this situation. If the same thought of “I’m a crappy student” was stated by a friend, how would we respond? Would we agree and voice other criticisms, or would we look for evidence that shows a more balanced perspective? Checking for double-standards refer to assessing whether we would respond differently if the same circumstances were happening to someone else.

3. The Survey Method

Sometimes our negative thoughts escalate because we feel we are the only ones to be thinking or feeling a certain way. There are times when this assumption is accurate, and there are also times when this assumption is false. By asking others for feedback, we’re able to assess whether there is any truth to our beliefs. The survey method normalizes our beliefs because it helps us recognize we are not alone in feeling or behaving in this manner. The survey method also helps clarify how some of our difficult thoughts are coming from unrealistic expectations.

Let’s consider a scenario where a child isn’t listening to a parent, and the parent snaps. In this case, the hot thought may include: “I’m a terrible parent for getting snappy” or “I’m not allowed to be angry at my child.” If we were to take a survey and ask others whether they also get snappy with their child, what kind of answer would we get? Chances are that other survey takers would acknowledge that they also have moments of frustration while parenting. If we were to share our beliefs that it is not acceptable to be angry with our children, many individuals would question the feasibility in pushing away a normal emotion like anger.

4. What other factors are involved?

five bulb lights — Photo by Rodolfo Clix on Pexels.com

This technique is referred to as “re-attribution”, and it can be very helpful to challenge thoughts about personalization. Rather than assuming that you are solely to blame for a scenario, re-attribution helps us step back and consider all of the factors that could have contributed to a situation. There are many points of influence such as environmental, cultural, physiological, psychological, financial, or social factors.

Many times parents personalize their children’s behaviours. While parents play a pivotal role in their children’s upbringing, they are only one influencing factor. Let’s consider a scenario where a child get into a fight with a classmate. If a parent personalizes this behaviour, hot thoughts may include: “I didn’t teach her the right ways to talk things out… Am I too aggressive at home?… I’ve been too lenient when she’s rough-housed with her siblings.” While these points may be valid, it does not acknowledge the impact of other influencing factors. For example, this child may have gotten into a fight because her classmate was egging her on. This child may have watched a TV show that modelled fighting, or seen peers manage conflicts in this way. Or, this child may have felt threatened, and went into a more subliminal fight/flight mode.

5. Test out your belief

A lot of times or our worries involve catastrophizing that negative things will happen. Unfortunately, because these negative consequences seem so frightening, we give up or give in to our worries. By testing whether your negative thought is likely to happen, you’ll either learn (a) the feared outcome didn’t actually happen, or (b) it did happen, and you were able to survive it.

brown eyes of scared young person — Photo by samer daboul on Pexels.com

For example, many of us feel nervous on a first date. We worry about not liking the person, or whether we’ll do something awkward. Rather than avoiding the date to prevent any negative scenarios from happening, we can actually test out our theory by going on the date. Afterwards, we’re able to make a more informed decision of whether that fear had any evidence to back up its argument. This strategy of challenging our negative thoughts through testing is the hardest to manage, and it’s helpful to connect with a therapist for additional support, such as the use of exposure therapy.

What works for you?

I’m describing these fives tips as if they were simple, and they aren’t always this easy. That’s partly because when we’re anxious, we are so caught in our emotions, that it’s hard to hear that logical part of our mind. However, what I’m hoping this post will offer you is the chance to try something different. You may end up picking one of these strategies and actively trying it, or simply pausing before an anxious moment and assessing if there is any evidence to it. Whatever you choose, I hope that the distress in challenging your fears are short-lived and that you start to see positive turns.

As always, please feel free to reach out or ask any questions.

Kasi

Schedule a free consult

Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Changing our relationship with our Inner Critic

Published on September 14, 2020August 18, 2022 by kshanmuk

When our inner critic shows up, it can be hard to talk it down or reason with it. This part of our personality can be fierce, harsh, argumentative and stubborn. This critical voice tends to be judgemental and demeaning. Internal Family Systems therapy has helped me change the way I view my own perfectionism, shame, and other critical parts. This doesn’t mean I’m always at peace when these parts of my personality show up. However, IFS helped me recognize that all of my “internal enemies” are here for a reason. Once I am able to understand why they are here, or what triggered them, I’m then able to negotiate for some space.

IFS uses a variety of techniques to help us externalise these difficult parts of our personality. By creating a bit more space, we can work to understand these inner critics without becoming overwhelmed by their words. We learn about the history of these parts, how they learned to do their current roles, and what they are fearful will happen if they no longer did these tasks. When the relationship with our critics start to heal, these parts no longer have to protest, judge, or demean you as intensely.

Short meditation introducing internal family systems therapy and parts work

Working with an inner critic can take time, practice, and sometimes, support from a clinician. In the meantime, I hope the following quotes help you start to shift the relationship you have with your own internal voices. These quotes are wonderful reminders that there is more to us than our inner critics, anxieties, perfectionists, and other challenging parts. These lines help us recognize that our critical inner voices were shaped based on early life experiences. Finally, these quotes remind us that we can separate from our thoughts. I hope they bring you some comfort.

SassyLife (2020, March 23) Taken from: https://www.facebook.com/poonam.naivein/photos/

I find the most aggravating thing anyone can say to a person when they’re feeling lousy is “be positive”. If it were that simple, we would have done it by now. Instead, the most freeing thing we can do is to accept that we are suffering. Like anyone else who is suffering from a critical voice, it is hard and it can be unpleasant. What often happens is that we try and stifle this critical voice and pretend it does not exist. This is understandable since we don’t typically like what it is telling us. However, ignoring this critical voice exists does not make it go away. Shoving it down to the deepest crevice of our mind usually creates backlash.

Improving relationship with your inner critic. Insights from internal family systems therapy. — Source: Quotefancy.com

What would it be like to actually accept that this critical voice exists? If you allowed this acknowledgement, what might change for you? Would you be able to reach out for help? Would you provide yourself more forgiveness when you react? Is it possible to start changing your view of this voice? Rather than being surrounded by shame or denial for having this inner critical, acknowledging its presence and intensity can allow you some space to proceed.

IFS helps us look at our inner critic in this externalized fashion. Think of your inner critic as if it is a loud, angry, temperamental child. There are many ways you can address this kid (e.g. screaming back, trying to convince it to stop, ignoring). None of these strategies actually help you understand why that kid is pissed off, or what he/she needs from you to feel calmer. Instead, can you become curious about this part of you? Can you let go of the agenda to make it stop yelling, and instead, be a soothing presence so that it can actually talk to you.

When you start to hear this critic, pay attention to other parts of you that may show up. How do you feel towards this critic? This question gives insight as to other parts of you that may be present. For example, there may be a part of you that does not like the critic, a part that is afraid of the critic, and a part that wants to give up. These various parts emphasize the existence of an internal system of parts. Typically, when an inner critic starts to speak, other protective layers pile up in order to protect you. This is like trying to talk to one angry, temperamental child in a classroom full of angry, temperamental children. No wonder our internal systems feel so overwhelmed when we try and do this work.

Our inner critic often focuses on telling us that there is something fundamentally wrong with us. This quote helps us recognize that there are so many influences that shaped us. Our history, our family of origin, our culture, and many other influences have helped to create this inner critic. In order to access your real core, it’s important to recognize that there are often wounds that get in the way. Once these wounds are addressed, we are able to have access to our true selves.

Life throws all sorts of difficult circumstances at us. We learn to cope in the best ways given the resources and skills we have at our disposal. At some point in time, your internal system learned that it needed a critic. This doesn’t mean that the inner critic is fair or kind or effective. However, it is what your system felt was needed to help you survive a difficult moment. When I think my inner critic as a young part of me that learned it had to criticize in order to protect me, I’m am better able to stay with that emotion. I am more open to validating its concerns, and thereby understand what it needs from me in this moment to feel safer.

Mindful observation is wonderful because it is so effective. However, many of us avoid mindfulness because it’s hard work to separate our emotional ties to a thought. When our inner critic gets loud, it’s easy to get swept up by its intensity. The idea of mindfully observing thoughts is being able to recognize that a thought is just a thought. There is nothing powerful about it. It is merely a phrase that comes to mind, which will be replaced by another thought in a few seconds.

Rather than mindfully observing, we often get hooked by the story of a thought. For example, if I wake up with a enormous zit on my nose, I’ll have a really hard time letting this thought go. I may have a train of thoughts such as “Crap! What the heck is growing on my face?… No one will be able to hear me talk, they’ll be staring at this monstrosity on my nose… Can I just hide in bed?” The alternative to being in my thoughts is to step back and acknowledge that it is just a thought.

Changing relationship with your inner child. Using internal family systems strategies and quotes. — Source: Self-Care Haven

Whether it’s an inner critic, anger, or any other difficult emotion, there is a huge shift in our internal system when we can recognize our part’s protective intent. If I can separate from the emotions tied to my zit-induced panic, I can appreciate that this thought comes from a place of wanting to present well. I understand that I would like others to have a positive opinion of me. Instead of my usual patterns, I can then provide self-compassion to this part of me that feels insecure. I can let this part of me know that I understand that it has my best intentions. With help from some IFS techniques, I can ask permission for this insecure part to step back, lower its intensity, and watch as I carry out my day despite walking around with the mother of all zits.

I want to leave you with these parting words. It takes time and effort to heal. You are doing your very best given the resources you currently have available. If you are curious about your inner critic, or wanting to shift your internal relationships, please reach out.

Cheers,

Kasi

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