Drinking and Postpartum Depression

September 5, 2022September 5, 2022 kshanmuk

Your world feels chaotic and there’s no escape. There are endless hours between naps, feedings and the constant fatigue. There is no one around to talk to and you feel overwhelmed and frustrated all the time. Having one more drink feels awful, but it gives you that escape you’ve been craving. Sound familiar?

Whether you want to call it an addiction or not, you’re noticing that you’re drinking more than usual. What was initially meant as a treat at the end of the day is starting to become a coping strategy (and, unfortunately, this one comes with some consequences).

If this sounds like your life right now, I get that you’re really struggling. This post is not about judging you or telling what is right or wrong. Addictions is hard. Postpartum depression is hard. For those who are in these circumstances, I hope the following post provides you some clarity and empowerment.

What is drinking doing for you?

Attempts to Self-Soothe:

Life feels chaotic and things feel too difficult to manage. There needs to be an end. It’s not possible to stay hyper-alert forever. You can’t always be watching the baby sleep. It’s overwhelming to be so stressed out at every feed. Drinking helps to balance your window of tolerance. When you’ve become a ball of stress, your body craves a way to settle down. So, a part of you turns toward drinking to help you calm down and relax.

Alcohol is an effective depressant. It forces your body to slow down giving that reprieve you desperately crave. In this way, drinking is an attempt to self-soothe. It’s a coping mechanism for helping slow down, numb out, or block off whatever it is you don’t want to address. You can’t necessarily leave the baby. You don’t want to call it quits as a parent. Drinking provides that mental escape when physical escape is just not possible.

Gabor Mate quote on addiction. Addiction as a coping mechanism during postpartum months. Addressing trauma to address addiction.

Lack of Internal Trust

If you’ve experienced enough trauma, neglect, shame or hardships in your life, you are likely aware that your internal system feels messy. You’re aware that many days you feel overwhelmed by worries, humiliation, guilt, anger, or self-hate. These parts of you are harsh and relentless. However, in their own unique way, they are trying to protect you. For example, you may have a critical part that shames you in order to encourage change. There may be a perfectionist part that nags incessantly so that you do not make mistakes.

When our system is full of these protective parts, it’s an indicator that there is limited trust inside. Rather than believing you are capable of handling difficult situations, your protective parts take over. For example, when you feel tired of parenting, there may be a harsh part that steps in. It yells at you to be grateful and reminds you of how hard it was to conceive. Your system doesn’t trust you to sit with the distress of parenting. It would rather help you avoid those thoughts by filling you with shame and guilt instead. This is not necessarily a helpful or effective manner of handling things, but it’s been like this for years.

Working with these protective parts are challenging. No amount of reasoning or negotiating in our minds creates that desperately sought after sense of calm. Our guilt, anxieties, shame and internal critics are forever yelling in our minds. So, a part of us starts to drink. It helps to quiet down all of those loud protective layers inside.

Why is it so hard to give up?

You already know that drinking excessively has consequences. But, why is it so hard to give up? If you’ve ever moved towards sobriety or harm reduction, you know this is no small feat. So, let’s take a look at what gets in the way of recovery.

Physical Dependence

So much of the addiction process is physiological. When we drink, the reward centres of our brain become affected. Suddenly, our brain produces an abundance of dopamine (a chemical that makes us feel good and influences our sense of pleasure). Once we get introduced to this experience of high-level dopamine, we start to crave it. By using, our brain is providing us enough dopamine that things feel so much better, calmer, and happier.

When substances are taken away, we feel depleted and depressed. Our brain is not producing the amount of dopamine that we crave. The normal level of dopamine production no longer feels like enough. For many folks, they can work through the triggers and traumas of their addiction, but their brain struggles to find pleasure in normal activities. It’s hard to read a book, talk to a friend, or go for a walk when you continuously feel so flat and apathetic.

Working through Pain Points:

When we use substances to cope with our reality, we have to consider what’s happening in our lives that makes us so desperate to escape? Drinking excessively to cope is not anyone’s first solution to fix a problem. Having a baby should not make us so overwhelmed that we’re needing a bottle of whisky every night. So what’s really going on?

When you are no longer drinking, you are left with pain points. Perhaps it is underlying trauma from childhood that keeps coming up. Being around a baby makes you remember all of your toxic and negative experiences as a child. Your pain points may come from unprocessed grief and anxiety. You feel like you ought to be happy with your newborn, but it’s been years of IVF struggles and multiple miscarriages. There’s no way you can let your guard down because what if one more bad thing happens? The part of you that drinks minimizes all of these pain points. Once the substances go, you suddenly have to face your traumas.

Working through pain points means looking at and processing the original trauma. If you continue to be triggered today by situations from the past, that urge to drink will keep coming up in order to protect you.

Habits

Habit formation can leads us to automatically reach for a glass of wine once the baby goes down for a nap. At the end of the day, we crave those several beers to help feel calm. We don’t even think or question our urge to grab a cigarette or a joint when we start our day. When it comes to these automatic routines, there are ways to change these habits.

4 Tips to Help with Drinking and Postpartum Depression:

1) Address the pain points.

Drinking is not the problem. It’s a means to make the pain stop. Until your postpartum depression, trauma, grief, and other pain points are addressed, that drinking part will want to self-soothe through substances. Healing from these pain points can involve a variety of interventions, including: individual therapy, support from friends and family, psycho-education, group therapy (for those in Kitchener, Stork Secrets provide wonderful care for postpartum depression), or medication.

2) Explore options for self-soothing

For many, accessing the interventions listed above is not possible. If this is your circumstance, you need to find alternative ways to work through difficult emotions. This is where effective coping skills can help. You need quick and reliable ways to slow things down. My favourite recommendation is the DBT temperature change exercise.

3) Find connection

Our shame drives so much of our need to drink. We worry that others will judge us. We assume they’ll reject us or mock us if they knew how much we are struggling. If there are people like this in your life, I’m sorry. These are not the supports you need right now. Find a safe community to talk to about your struggles, such as neighbours, friends, family, partner, colleagues, or a community-based mental health group. Having others who accept you and love you, just as you are, plays a significant role in healing.

4) Get to know your cues and rewards

One of the best tips for changing our habits is understanding our cues and rewards. Pay attention to what triggers you. Are you most likely to use when the baby refuses to go down for a nap? Are you prone to having a bottle of wine starting at supper time? Pay attention to the time, the place, the people and circumstances. Next, notice the rewards that you get when you drink. Are you able to pass out? Can you suddenly tune out the crying and shrieking? Are you able to manage boredom or frustration? Does your anxiety reduce?

When it comes to changing habits, we want to make sure that we intervene with a different habit for these cues AND still receive a similar reward. For example, once the baby has done screeching for an hour and finally falls asleep, you may experience an urge to drink. It’s the only way to release all of that pent up anxiety and tension inside of you. In this situation, the cue is the baby shrieking before nap time. The reward is releasing anxiety. We want to bring in an alternative habit that will lead to the same result. You may find that running on your treadmill for ten minutes releases some anxiety. Perhaps playing loud, angry music on your headphones provides you some relief. You could work with a foam roller and target those parts of your body that are carrying the most tension. Pairing these new activities shortly after the baby has gone down for a nap leads to shifting out of the original habit.

Final Thoughts

Addictions is not simple, and one blog post cannot address the complexities of this mental health struggle. If you are struggling with drinking and postpartum depression, please speak with a safe and trusted person or a therapist. This is not a matter of will power. You are worthy of effective support and help.

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

Pregnancy and Postpartum

Struggling with body image during pregnancy

June 14, 2022July 20, 2022 kshanmuk

struggling with body image. weight scale. prenatal appointments and weighing in

The worst part of prenatal visits? Going to your healthcare provider’s office and stepping on that scale at Every. Single. Appointment. As if you need any reminder that your weight is increasing at an alarming rate. You know this. You feel huge. No other pregnant mom looks as big as you do. You shouldn’t have eaten that extra serving. Why won’t these pants fit anymore? … Do any of these thoughts sound familiar? Struggling with body image is a huge frustration during and after pregnancy.

Being pregnant can be incredibly challenging if you’re struggling with body image or disordered eating. Yes, rationally you’re aware that this peanut growing inside of you is taking up a lot of real estate. You’ve read all of the instagram posts about body positivity, and know you “shouldn’t” be feeling this way. But, all of that aside, you still feel lousy when you see your reflection or step on the scale. So what can you do? If you’re struggling with body image, here are some thoughts to consider:

Re-assess “normal weight gain” in pregnancy

When you’re pregnant, your body is truly being taken over. Your metabolism shifts, your energy wanes, stretch marks suddenly appear. It’s natural, and it’s hard. When you’ve spent a long time meticulously taking care of your weight and appearance, these drastic changes to your body feel jarring. Check in with yourself about how you are seeing these changes. Is there shame and personalization involved? Are you feeling at fault for gaining “too much”?

body mass index (BMI) and impact on body image. Addressing BMI during pregnancy. healthy weight gain guidlines

Unfortunately, we have been given guidelines that it’s “normal and healthy” to gain 15-30 pounds during pregnancy. But this number is based on BMI, which research continues to point out is a flawed system for assessing health. Your recommended weight gain varies on so many factors. This number shifts based on whether your BMI was over or under prior to pregnancy. Your weight gain will vary if you are having twins. The number on the scale will look different if you’re struggling with hyperemesis gravidarum or if you’re managing your nausea by eating differently. In reality, only a third of pregnancies stay with the recommended weight gain, while about 50% gain beyond this number.

Speaking for my own body, with my first son I gained 45 pounds during my pregnancy, whereas I gained 20 with my second. I didn’t do anything differently. Bodies changes and babies are different. It isn’t personal. You’re not doing it wrong. That number on the scale doesn’t say anything about you or how well you are doing this pregnancy.

It will not be forever

This is not your forever shape or size. I do not have a crystal ball to confirm you will go back to your pre-baby weight, and I won’t deny that perhaps you’ve gained weight. However, the size you are while pregnant does not stay on forever. Whether it’s 6 weeks postpartum or 6 months postpartum, your body will change after delivery. Remind yourself as many times as needed that it took you 9 months to help your baby develop. Give your body at least 9 months to settle back to what it considers is the “new normal”.

Find safe others

Talking to safe person about body image. Struggling with body image during pregnancy.

It’s easy to feel isolated with our crummy feelings. Body positivity is an amazing trend that our culture is trying to lean into; however, it doesn’t leave much space to acknowledge when we are struggling. When we feel ashamed or alone in our thoughts, it can be debilitating. We become worried that others will judge us, shame us or minimize our feelings. If you have judgmental folks like this in your life, they are not the ones to turn to right now.

Find those who truly appreciate how hard this is for you. They know that you want to be healthy AND they respect that body image is something you’re struggling with today. This person doesn’t need to know how to fix the situation. Instead, they just need to let you know that you’re heard, you’re loved, and you will always be safe with them irrespective of how your body looks.

Use movement

using movement to help address prenatal weight anxiety. walking to help with pregnancy and body image

During pregnancy, find ways to move whenever possible. Let go of the standards that you used to meet whether it was a certain distance, speed, repetitions, or weight level. Focus instead on what movements means to you. For me, movement provides me opportunities to let go of stress, it helps my body feel strong, and it helps me feel energized. Once I stopped trying to meet my old standards, it felt easier to accept that this is what exercise could do for me today.

Our Society and Thin Privilege

I won’t deny that being thin and beautiful doesn’t have privileges (read more about thin privilege). Thin privilege allows for your weight to not define you and how you move through your environment and world. There is an awful amount of discrimination with fat phobia. People living in a larger body have been overlooked, groaned at, or mocked because of their weight. In these situations, being thin means they will finally receive respect and courtesy from other people. Being thin means the ability to walk into a store and actually be able to buy clothes. If you’ve been subjected to others’ fat phobia, you may have coped by maintaining a certain weight. Pregnancy has thrown this weight plan out the window.

If being pregnant or weight gain puts you into a space of losing your self-respect or self-worth, that’s not okay. It’s not okay for society to put you in this position or for you to suffer simply because of the way your body naturally flows. So how do we learn to externalize this? How do we shift from assuming there is something wrong with us to there is something biased and unfair about the culture we live in?

Tips for boosting body image:

tips for improving body image. shifting the way we think about our bodies. diet culture. comparing.

Diversify what you see: Follow influencers of all shapes and sizes. Follow those who look like you and don’t look like you.
Stop the comparison game: Envy is a tough emotion to contend with, and it leaves us feeling lacking. Start by checking the facts: do you know for sure that this person truly has more than you? Do these factors make them better or happier than you?
Highlight your own positive attributes: Notice what is awesome about you, and spend time acknowledging these positive traits. e.g. expressing pride in your career or grades, appreciating the health of your relationships
Become critical of toxic diet culture: We all know it’s out there. Start by challenging these constantly shifting body ideals. Unfollow or speak up about the companies and individuals that make you feel bad about your body.
Focus on what your body is doing for you: What are your thighs, arms, and belly meant to do? What are their functions? Focusing on their role as a function vs.

What are you avoiding by focusing on body image and food?

Sometimes body image acts as a (horrible, awful, exasperating) scapegoat for our actual struggles. By focusing on that number on the scale, you may find that you can avoid addressing other things. You spend hours staring at the fridge, planning meals, going to the gym, organizing your closet with “comfy” clothes, that you don’t have time to deal with the real stuff.

We all cope in different ways. Previously, you may have turned to a glass of wine, a cigarette, or going out dancing to get rid of all your stress. Now that you’re pregnant, these coping mechanisms aren’t as available. Food, on the other hand, is always there and doesn’t take as much effort. It soothes our stressors and pains. But, using food as a coping mechanism offers a temporary solution. It doesn’t allow us to address the actual cause of stress and turmoil in your life.

So ask yourself, if you didn’t spend all this time on body image and food, what would you be left with? Would you suddenly have to address your loneliness? Are you more aware of your anxieties about work, the state of your finances, or your struggling relationships? If we looked at negative body image as a coping mechanism (again, not vouching that it’s a nice or effective one), we realize it’s trying to prevent you from dealing with a deeper vulnerability.

Addressing the original trauma: When did this struggle with body image start?

body image and teenager. Struggling with body image in pregnancy. trauma from childhood

Body image rarely shows up in pregnancy without some form of history. Consider when else in your life have you struggled with this issue. Have you been painfully aware of your appearance since adolescence? Have you managed to shove aside any struggles with your appearance by exercising and maintaining a “healthy” diet? When did you make the connection between your appearance and your self-worth? How was this message taught to you?

When it comes to body image struggles, pregnancy makes things worse. However, it’s not the culprit. After your little one is born, things may feel manageable with dieting and exercise, but it’s a fragile set up. Anytime that weight starts to increase, that same panic may come back.

If this has been your experience, then it’s important to recognize that there is some earlier trauma to be addressed. Your body image struggles could have slowly formed while participating in gym class, listening to your mom comment about her (or your) weight, looking at skinny actresses and models, or a myriad of events. These moments stayed with you. That vulnerable part of you still worries about your appearance, fitting in, or whether you will be considered “worthy.” This is where therapy can be helpful in processing these earlier emotional burdens.

Reach out

If you or a loved one is struggling with body image during pregnancy, reach out. Therapy is a safe space to voice your concerns and work through these difficulties. Schedule a free consult call to see if we would be a good fit.

Take care,

Kasi

Schedule a free consult call

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

Mental Health

How to overcome shame

May 27, 2022August 17, 2022 kshanmuk

Your system holds a lot of shame. There is shame about who you are as a person. You feel that you do not belong and are unloveable. You have been rejected by others. There’s no way you’ll put yourself out there again. You carry shame about earlier decisions. Because you acted this way, you feel raw and exposed. There is a constant sense of dread that reminds you, “Never again will I make that mistake.” You hold a lot of shame about failures. You’ve messed up, said the wrong thing, wrote the wrong answer. Your stomach goes in knots just thinking about it. You feel ashamed about inaction. It repeats incessantly that you should have done something, acted differently, or reacted faster. You feel ashamed about who you are as a parent. You keep thinking your kids would do better with someone else. When all of this is hurtling towards you, how do you overcome shame?

Dealing with Shame

Overcoming shame. Why it is so hard to deal with shame.

It’s hard to acknowledge our shame. We worry that others will judge and reject us for our deepest insecurities, so we don’t speak up. Because shame is so uncomfortable, we tend to push it away. We avoid addressing it, only to have it repeatedly show up. We feel awful, alone, and hopeless in this pattern.

Thanks to Brené Brown, most of us have are familiar with the benefits of addressing shame and vulnerability. In theory, we know one of the best ways out of shame is to be nice to ourselves and accept that we are imperfect human beings. Dealing with shame involves validation, self-compassion and seeking connection with others. That’s the simpler answer. The more complicated answer involves addressing all of the parts of us that block this work. To overcome shame, we have to deal with many other internal layers (e.g. our inner critics, our avoidant parts, our self-hatred, our panic, and other struggling emotions).

Getting to know our parts:

Internal Family Systems therapy recognizes that our mind is compartmentalized into protective categories or “parts”. There are three different parts inside of us: Managers, Firefighters and Exiles. In order to overcome shame, we need to understand how these parts play a unique role in improving and delaying our healing.

Exiles

Overcoming shame. How our early experiences create exiled parts. Internal Family Systems therapy. IFS and shame

During traumatic and painful events, our minds suffer. We struggle to get through these horrible events. As time goes on, we start to carry negative beliefs about ourselves based on what we experienced. We suddenly feel we are insignificant, weak, unattractive, incompetent and don’t belong. These wounded parts of our personality are what IFS refers to as “exiles.” Exiles absorb the impact of traumatic and difficult events. Exiled parts carry our vulnerable emotions and beliefs. They learn to feel ashamed of themselves, that there is something fundamentally bad and flawed about them. Shame is not an innate feeling. We are not born feeling ashamed of ourselves. It is something we’ve learned based on our environment and experiences.

Sitting with our shameful exiles can feel unbearable, so we form some protection. We do whatever we can to prevent these parts from becoming triggered. We do whatever we can to shut them down quickly if they are triggered.

Managers

Manager parts. IFS and how to overcome shame. Internal family systems therapy. Kasi Shan Therapy offers counselling support in Kitchener, ON

“Managers” are the first layer of protection. These parts help us stay safe by doing whatever is possible to stop our exiled parts from getting triggered. For example, if your exiles believe that you are unattractive, your manager parts may pester you to work out daily or wear makeup. If your exiles cannot trust your own judgement, then you may have manager parts that constantly seek reassurance from others. Worried about being stupid? Your manager parts prevent you from every trying or moving up the career path so your intelligence will never be assessed.

Manager parts focus on preventing us from feeling hurt, wounded, ashamed, or any other exiled emotion. They do this by pushing us, criticizing us, reminding us to keep going, doing more and never becoming vulnerable again.

Firefighters

firefighter parts.IFS and overcoming shame. protective layers to deal with shame

The second layer of protection is referred to as “firefighters.” When our exiled parts are freaking out inside, our firefighters know it’s important to contain that flame. So they react. They work on quick fixes to settle the fire down. They use distractions and various forms of self-soothing when our system gets triggered. For example: someone calls you unattractive, your firefighters seek comfort in a nice bottle or three of wine. You realize you made a mistake at work, your firefighter parts draw attention away by yelling at other colleagues. Your exiled part is triggered for overeating, your firefighters compensate by purging and over-exercise. Firefighter parts are aware that the pain has come up, and they focus on getting rid of that pain as quickly as possible through any means possible.

Shame Starts Young

When we are young, we long to be loved and accepted. We want to belong and feel significant. When our parents meet these needs, we’ve struck gold. Our system can relax when we make mistakes. We don’t personalize it, and we move on fairly quickly.

For those of us who have not “struck gold”, our system gets hijacked following a mistake. We fear reproach, criticism, disappointment, anger, or any form of negative feedback from our caregivers. As kids, we don’t have a whole lot of resources, so we internalize these messages. We start to believe that there is something wrong with us: We are a screw up, we are incompetent, we do not deserve good things. This moment creates our exiled parts.

How our parts become intertwined in the shame pattern

exiled parts. Internal Family systems therapy and overcoming shame. IFS

Despite knowing that we will continue to be hurt and rejected, we can’t help but reach out to our caregivers. What other choice do we have at a young age? Our exiled parts are always looking for a better ending. They want redemption. They want our parents to somehow stop their patterns of anger and criticism, and instead, turn to us with love and warmth.

Our manager parts are also paying attention to these attempts. Our managers learn what is and is not effective in keeping your exiled parts from getting in trouble and feeling ashamed. They are aware of what pisses off your parents, and triggers your exiles to feel ashamed once again. For example, if you know that being slim and attractive gets your mom’s approval, your managers will continue to berate you to go to the gym and start another diet. Ironically, these managers shame us for making the wrong choices in order to get us to learn. You don’t need your mom to continue to shame you, your manager parts will repeat her words for you.

endless cycle between manager and firefighter parts. IFS and handling shame.

Unfortunately, our exiled parts keep trying. Your mother may present as biting and cold, but this doesn’t stop your exiled part. You continue to invite her to outings, provide thoughtful mother’s day gifts and call every Sunday. When you are hurt and rejected by her lack of interest, your firefighters come in trying to extinguish the pain. They encourage you to drink, hook up with a random person, lash out at your partner, or any other means in hopes of releasing this shame. And, once again, our managers (e.g. that harsh inner critic) attack for making poor decisions.

Working with our protective parts to overcome shame

ogres, onions and protective layers. Dealing with shame metaphor

Forgive me for using a Shrek reference here. IFS reminds me of Shrek’s comments that ogres are like onions: we all have layers. There are layers and layers of protection we use to keep our exiled parts safe. We can’t deal with shame if we do not address the managers and firefighters that maintain our shame cycle. As Donkey wisely reminds Shrek: “”You’re so wrapped up in layers, onion boy, you’re afraid of your own feelings!” We get so caught in protecting ourselves, we get scared to actually help our exiled parts.

To overcome shame, we have to first work with our protective parts. It’s hard to show love and self-compassion if a harsh critical voice keeps dismissing your kindness. You may have difficulty forgiving yourself if a firefighter part continues to binge drink. Shame rarely works alone; it always come with protection. So to overcome shame, we have to work with your entire system. We have to gain trust and permission from these protective parts to give you some space so that you can work with your exiles.

Internal Family Systems Therapy and your shame

In therapy, I focus on creating a safe space for your entire system to show up. This includes all the parts of you that are eager to get started, as well as the parts of you that dread working on these issues. This is normal. When we have experienced shame or been shamed by others, our system launches into a protective stance. It’s braced for rejection and judgement, even in the context of a safe therapy setting. It’s important to take the time to build that therapeutic trust before launching in to your most vulnerable concerns.

Shame deserves self-compassion, belonging and validation. Healing comes from witnessing these painful moments, learning to see the safety in today, and trust in your own capacity to handle things differently. The resources you had back then are not what you have available today. Your exiles and protective layers aren’t always aware of that. They often see you still stuck in that place of trauma, and react accordingly.

Reach out

If you are struggling with shame, and would like to work with your internal system, reach out. Schedule a free consult to see if this is a good fit for you.

All the best,

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

Pregnancy and Postpartum

Shame and the postpartum experience

April 5, 2022July 20, 2022 kshanmuk

shame and postpartum. perinatal mental health. shame and pregnancy.

One of the biggest aversions to attending postpartum therapy is shame. You feel ashamed that your emotions are messy. This isn’t like you. Normally, you’re calm and cool. But, suddenly your hormones are all over the place, your hair is a mess and you can’t remember the last time you showered. There hasn’t been a single day where you haven’t burst into tears or rage.

You feel ashamed about your relationships. It feels like a huge risk to acknowledge how you truly act around your family. What would the other person say if you admit you don’t really like your baby? What if you told them you sometimes screamed at your children? Are they going to judge you if you tell them you’ve stopped breastfeeding? Would you get mocked for admitting you haven’t had sex in months? What if you revealed that you suddenly can’t stand your spouse? How will the other person react?

It’s incredibly vulnerable to open up to a stranger, especially if you worry how he or she will respond. So rather than talk, you stay silent. Shame feels awful, but it protects you. It keeps you safe from being judged. But it also means you are stuck with all these difficult thoughts and feelings bubbling inside.

The shame of mental health

Despite all of the social media posts, campaigns, and recognition about mental health today, there is still a stigma in admitting we are struggling with mental illness. You may worry about what it means to be attending therapy or starting medication. Does it make you incompetent? Are you still able to say you are a good parent if you also admit you are mentally unwell? How do you cope with your family members telling you to “suck it up” or “get it together?” All of these shameful questions and thoughts prevent you from admitting that you need help.

Perinatal mood and anxiety disorders are genuine illnesses. During pregnancy and postpartum months, an individual could live with anxiety, depression, OCD, bipolar disorder, or PTSD. The chance of experiencing any one of these illnesses is not uncommon (e.g. approximately 1 in 4 Canadian mothers reported experiencing symptoms of postpartum depression or anxiety).

As with any illness, you deserve appropriate treatment and care. It is not a matter of will power. We cannot wish it away. My favourite recommendation is to consider how you’d talk to a friend in a similar position. Chances are you would be more compassionate and open-hearted. For example, following a surgery, you would encourage said friend to attend medical appointments, take prescribed medications, and follow their health team’s recommendations. In the same way, would you be able to give yourself the permission to seek the treatment and attention that your mental health needs?

What if the therapist judges me?

Every therapist claims they are nice and nonjudgmental. That doesn’t mean you truly believe it. For those cautious and skeptical parts of you, I want you to know, that’s okay. It’s absolutely okay to have your guard up. Starting therapy feels awkward. As with every relationship, it takes time to build trust.

Take the time to share slowly, if that is what your system needs. Watch how your therapist responds to your words and concerns. You will notice that you either feel more settled and at peace, or if your shame increases. Trust this internal feedback. If you are comfortable, let your therapists know you feel this way, and see how they respond to your words.

Will I get in trouble?

One of the biggest fears that pushes clients away from voicing their experiences is the fear of how others will react. In prenatal and postpartum therapy, I see many clients hesitate to talk about how they truly are with their children and relationships. Not only are they managing their internal shame, but they are weary of judgement and negative consequences. Clients are often fearful because they fear the truth will lead to the therapist ending the relationship, calling the Children’s Aid Society or disliking the person. So let’s address these fears:

1) If I am truthful, my therapist will end the relationship:

In most cases, therapists will only end the relationship if they are outside of their clinical scope or the treatment goals have been met. If you have met your treatment goals, that’s wonderful! Celebrate all of your hard work. You don’t necessarily have to end your relationship with your therapist, but you can talk about tapering off sessions or increasing the time in between appointments. If it’s loneliness that drives you to stay, your therapist will support you in exploring how to improve outside relationships. It is not okay that the therapy room is the only space where you are heard, validated and supported.

If your counselling goals are beyond your therapist’s knowledge and skills, they will admit this to you. It isn’t personal. Consider your experiences with other specialists. You may really love your hairdresser, but this is not the person who can necessarily answer your medical concerns. You connect with the clinician who is best able to meet each of your needs. If you keep asking your hairdresser for advice on all things medical, neither of you will leave satisfied or confident that your goals can be achieved.

2) What if they call the Children’s Aid Society (CAS)?

This is a common myth that prevents parents from reaching out for postpartum therapy. Postpartum depression often shows up as rage, anger, outbursts and distress. I see many parents who are frustrated with themselves and with others, but are too scared to ask for help in fear of being reported. Postpartum depression deserves respect, compassion and appropriate support. The only reason to reach out to CAS is if there is a genuine concern about a child’s physical or emotional safety. If there is a worry about abuse or neglect, your therapist will ask you directly. However, yelling at your child does not mean an automatic phone call for outside authorities. Having negative or intrusive thoughts does not mean we are automatically contacting outside authorities.

3) What if my therapist dislikes me?

I can’t speak for other therapists, but I can speak for myself about this worry. The beauty of Internal Family Systems (IFS) therapy is that IFS therapists are always looking for positive intentions. This means, irrespective of the behaviour, words, or emotion (anger, infidelity, jealousy, disgust, etc), your IFS therapist is always trying to understand how there are parts of you trying to get you through a difficult moment. It’s not about assessing whether the outcome is successful or whether the efforts are worth it. It’s about understanding the actual intention.

IFS therapists go to their own therapy. It’s how we do the work we do. If I feel triggered in a session, that’s an indicator that there is some part inside of me needing support and attention. It has nothing to do with you; it has to do with my own history and experiences. That part, similar to yours, will need support and processing. I take it to my own session or my supervisor. IFS therapists’ intentions are always to keep our parts out of the session, because in therapy, it really is about the client. It’s not about my agenda or my needs; it’s about yours.

The shame of not meeting our own expectations:

You had lots of hopes and dreams of how your pregnancy or postpartum months would turn out. Chances are you did not wish for mental illness.

Many of us struggle when our expectations are not met. We feel a sense of shame and inadequacy in falling short. You may have hoped to be a Pinterest-parent, and realized you have zero interest in arts and crafts. Perhaps you thought you’d enjoy spending days with the baby, and found you were bored out of your mind by week 4. Maybe you thought you’d ace the whole sleep training thing, only to be struggling 15 months later with a toddler who refuses to go to bed. Somehow these results create a sense of failure that we equate into our self worth.

For any parent who struggles with this sense of “inadequacy”, please know that you are not alone. We all have moments where we worry about being good enough parents. Remember that you have so many years ahead of you to figure this out. We often label ourselves as success or failures, but we fail to pay attention to all the efforts and practice we need to improve our skills. We will screw up many times, and we will learn constantly. In this way, there is always space for us to grow.

goals, high expectations. shame and parenting

It isn’t fair to assume we’ll be great at parenting from day one. Think about how it was like when you first learned to drive. In the start, you were in the “conscious incompetent” stage where are very aware that you have no idea what you are doing. However, with time, you get to a place where you can automatically drive your car. Unfortunately, when we are at this place of “unconscious competence” (a.k.a. “I don’t have to think about it, I can do it in my sleep”), we forget how much we initially struggled. We forget the intensity and shame of not doing well.

Make it safe

We can all play a role in reducing the shame of mental illness and perinatal mental health. Talk about your experiences openly with safe others. Offer validation and compassion to those who are in this phase of life. Reach out to a therapist that you can trust. We can work to shift away from judgment, and instead, appreciate that we are all doing our very best.

Warmly,

Kasi

Book 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.

Trauma

Starting trauma therapy? Tips to support those initial fears

March 16, 2022August 18, 2022 kshanmuk

It’s normal to feel a bit nervous when you’re connecting with a new therapist especially when you’re starting trauma therapy. This is the person you intend to tell your vulnerable history, and pray that they know what to do with all that information. The idea of opening up to share your lowest times can be an aversive factor in starting the work. I hope the following tips will provide you comfort and guidance as you consider starting trauma therapy.

Acknowledge the hesitation

starting trauma therapy. nervous. anxiety

There are parts of you that are cautious of opening up. Why wouldn’t they be? If you are nervous, there is a reason for this caution. So take a moment and pay attention to the thoughts and feelings showing up right now. What are those cautious parts of you needing in order to feel safe? Here are some questions to consider:

Is your anxiety asking you to go slowly?
Are these cautious parts of you concerned about becoming overwhelmed?
Are these parts worried how your therapist will react once you share your experiences? Have you been shamed by others in the past about this experience?
Does your system need time to feel safe and build a relationship before it feels willing to open the door to the past?
Are your anxieties worried about what they will find out if you start this process?

Everyone has reasons for hesitating, and it’s important to make space and create safety for those fears. When it comes to trauma therapy, sometimes going slow IS moving fast. Parts of you may be frustrated that you’re working at a glacial speed; however, taking the time to process slowly may be the safest option. There are safe ways to process traumatic memories without reliving or re-experiencing the events. The point of therapy is not to trigger you. Therapy should not make you reenact horrible events that you have already survived. It’s more about dual awareness: your system will slowly learn to talk about these events knowing that you are safe in the present moment.

You get to lead

This may sound obvious, so humor me as I clarify this point. Most folks come into therapy with the goal of “feeling better”. However, there are parts of their life that are an open book to review and many topics that are completely forbidden. This is fine! However, let your therapist know these boundaries. You may have experienced an eating disorder as a child. Perhaps you survived a sexual assault. You may be grieving the loss of a parent. Despite knowing this history, you may not want to open the door to these topics. Your therapist should be respectful of this boundary. At the end of the day, you are the boss in therapy. This is your life, and this is your wellbeing. You get to decide what feels most important to address. There will be times as you start trauma therapy when you realize these old wounds keep coming back. When this happens, your therapist will be honest with you and point out the value in addressing these topics. However, you are ultimately in charge of deciding whether this issue is worth exploring.

Your feedback matters

You can let your therapist know when something is not working. This may feel very unsettling, but protecting your therapist’s feelings provides only short-term relief. It doesn’t actually help you in your recovery. That isn’t fair to you, and your therapist may not be aware that you are going through this internal battle.

You can ask questions, clarify where treatment is going. When it comes to starting trauma therapy, many folks are not clear on how therapy works, or what a session will look like. You are welcome to ask at any point in time about your questions. Whether it’s been a few weeks, or a few years, it’s fine to clarify! Therapy is meant to be a safe space to build a relationship. It should feel safe to ask questions or voice uncertainties.

Therapy takes time

This may seem obvious, but it’s an important factor to consider with starting trauma therapy. You may have seen TV shows where a sassy, brilliant therapist says some profound statement and the client walks away completely changed. This isn’t really the case in real life. Sure, you may learn more about yourself at each session. You may also have a deeper patience and openness to those difficult parts of you. Therapy is about having a better relationship with yourself. Having insight into your internal system is helpful and can absolutely make you look at the world differently. Understanding what all of your “problematic symptoms” are trying to do can help you shift to appreciating these parts of your personality. However, as with every relationship, it takes time. It takes time to build this understanding about yourself. It takes time to start to trust yourself.

Therapy is not forever.

Sure, therapy can sometimes take a few years to work through old wounds and feel regulated. You may continue more for the sake of check ins and maintenance work. But, this does not have to be a permanent arrangement. You are at the lead of deciding when your goals feel complete. The beauty of working in private practice is that clients can reach out when they want to work on something, and can leave when they feel this has been adequately addressed. If you hesitate to start trauma therapy because you fear you will be ongoing, please know that this is not the case. Your therapist is forever working him or herself out of a job. That’s the point of our roles. We support you in creating internal leadership so that your emotions can show up, express themselves, and feel safely supported by you.

Don’t settle

Just because you start with one therapist does not mean you are stuck with him/her forever. Research shows that the relationship matters. The quality of the relationship you have with your therapist is a solid predictor of how treatment outcome (irrespective of the type of therapy that is offered). What does this mean for those who are hesitant to start therapy? Ask yourself if you feel truly comfortable with the therapist. Is your clinician hearing you and understanding your needs? Do you feel judged? While you may not enjoy vulnerability, does it feel safe to be vulnerable in front of your therapist? Is there compassion? Your therapist should have a positive regard for you. If not, this isn’t the right fit.

Reach out

If you have any questions about the above details, reach out for a free consult. Starting trauma therapy could finally provide that relief you’ve been searching for.

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

Mental Health

The fear of abandonment: Why am I trying so hard?

February 1, 2022August 18, 2022 kshanmuk

Does the fear of abandonment push you to act in undesirable ways? How often do you jump through hoops to suit another person? Do you feel a constant pressure to do more and be more so that others are not upset with you?

To cope with these fears, you may have learned to keep your guard up. Rather than acknowledge your humanness, you may try and hide inabilities or flaws. By demonstrating only these “acceptable behaviours”, you have managed to stay safe. This way, others will not walk away, be upset or disappointed with you.

Sound familiar?

The need for connection

I hope the above words do not cause shame or embarrassment. I am writing them to emphasize the commonality of this experience. Many of us fear being alone. This is normal. In its own complicated way, the fear of abandonment is meant to be helpful. To be human is to want connection. From an evolutionary standpoint, those who had community, had more resources and support.

“We humans are social beings. We come into the world as the result of others’ actions. We survive here in dependence on others. Whether we like or not, there is hardly a moment of our lives when we do not benefit from others’ activities. For this reason, it is hardly surprising that most of our happiness arises in the context of our relationships with others.
Dalai Lama

Understanding the roots of our fear:

The fear of abandonment does not come out of nowhere. It is a learned survival mechanism that comes after experiencing some form of hardship. I want you to consider how your own history. How did your experiences influence having this fear? The following questions can help you explore further:

Grief and Loss: Have you lost an important person in your life growing up? Did this experience cause you to worry about others leaving you?
Learned messages from parents: What were the rules growing up? What did your parents require of you? What behaviours did they praise and what did they reprimand? How did your parents respond to your successes versus failures? Did your parents’ love feel unconditional?

Learned messages from culture and society: What was idealized in the media? What were the rules that your parents followed, and then, asked as of you? If you witnessed others rebel outside of these standards, how were they treated?
Friendships: What messages did you pick up from your friends about fitting in? What caused fights? Did you experience rejection from peer groups? How did this come about? What did you do to “repair” the relationships?
Romantic relationships: How did your romantic partners treat you? What did your partner expect in a relationship? How did you handle things when the relationship ended? What happened when you set boundaries? Were your words respected or were they questioned?

Managing the fear of abandonment:

If you’ve ever struggled with the above scenarios, chances are that your system learned to protect itself with some careful strategies. There are two common protective patterns that show up to manage this fear of abandonment. The first strategy is to work incredibly hard to meet the expectations of others. These folks tend to:

Predict what will make others happy
Be hyper-alert about verbal and non-verbal cues (tone of voice, facial expressions, comments, etc)
Feel triggered by negative feedback because they fear it means others no longer like you.
Focus on people-pleasing tendencies to maintain peace
Say “yes” often (despite it feeling uncomfortable with their boundaries)

The second protective pattern that arises is the urge to stop trying all together. After all, if something scares you, why put yourself in that situation? These folks often appear dismissive. They may spend a lot of time alone. They prefer not to rely on others, or avoid getting close to someone. They fear that these actions will put them in a vulnerable place where they get attached to another person, and this person could have the power to hurt them.

What do I do?

fear of abandonment. Fear of being alone. How to address.

Working hard to meet others’ expectations is a form of coping. You don’t have to face the fear of abandonment so long as you follow these expectations. Staying isolated or avoiding any close relationship is a form of coping. You will not deal with rejection so long as you never get to a place of vulnerability.
At the end of the day, coping strategies are meant for short-term relief. They address the anxiety in that moment, but they do actually fix the core issue. Unfortunately, the fear is still there. So what else can you do? The following options can lead you to more long-lasting relief:

1. Seeking therapy to address the underlying wound.

If you have survived hardships like the loss of a parent, bullying, or abusive relationships, these are not small issues. Your system has experienced rejection and loneliness. It learned to cope in the safest way it knew at the time. Trauma approaches like EMDR and Internal Family Systems Therapy are wonderful strategies to help address the root causes for the fear of abandonment. Your system can feel less fearful once these underlying wounds have been healed.

2. Assess if your relationships are healthy.

This is obviously easier said than done. There is a lot of grief and stress in acknowledging unhealthy relationships. However, I want you to consider what may happen if you did not comply with someone else’s expectations. Will they abandon you? Is their love truly unconditional? Sometimes we need to break away from our unhealthy attachments to make space for new healthy relationships.

3. Is there truth to your fears?

Sometimes are our thoughts are just thoughts. They don’t have a lot of evidence behind them, but the fear alone drives us to stay complacent. If it is safe, talk to the other person and ask how they’re feeling. Clarify what you’re seeing or hearing, and ask about the other’s intentions. You may perceive a look or comment to mean abandonment, whereas the other person has zero intention of ending the relationship.

4. Take small steps to trust.

For those who are fearful of committing to a relationship, consider what feels like a safe starting place. You may not be ready to let your colleagues know about your deepest secrets, but you may feel more comfortable sharing how your weekend went, or discussing a difficult work project. In this situation, exposure therapy may be helpful in creating a shift.

5. Slow down

In similarity with exposure therapy, I encourage you to take a step back from the “do more, be more” approach. What happens when you don’t work so hard? What happens when you make small mistakes? I know this option isn’t easy, and I suggest you take the smallest step manageable in creating this change. It’s important for your system to be cautious and monitor how change is perceived. You may surprise yourself in seeing that a) others do not leave when you show your human side, or b) you start to step away from these difficult relationships.

Learn More

If you’d like to learn more about your own system, or you’d like to address fears of abandonment, reach out.

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.

Trauma

Should I be concerned about PTSD?

September 12, 2021July 20, 2022 kshanmuk

If you have survived a traumatic experience, it’s natural that you are feeling worried about how to proceed. You may have many concerns running through your mind: How long will I feel this way? Am I supposed to seek treatment? Is it normal for me to feel like this? Whether it’s an unsettling birth experience, a difficult pregnancy, a sexual assault, or any other traumatic event, we are left feeling vulnerable and distressed. This post is for anyone concerned about experiencing posttraumatic stress disorder (PTSD). I hope the following information will provide you some clarity and empower you to seek the support that best meets your needs.

What is PTSD?

PTSD is a mental health diagnosis that occurs after an individual has survived or witnessed a traumatic event. What qualifies as a traumatic event differs for every individual. Whatever the circumstance, the individual experiences a significant threat to their physical, emotional or psychological safety, or the safety of a loved one. The situation is so distressing , that the person feels unable to cope.

In working with prenatal and postpartum parents, I see a lot of caregivers who have experienced trauma in the following circumstances:

Is it PTSD? What to do about trauma. Kasi Shan Therapy: counselling in Kitchener, ON

Prenatal Loss: e.g. stillbirths, miscarriages, unsuccessful IVF treatment
Unplanned pregnancies and abortions
Domestic violence, affairs, or marital separation
Pregnancy complications: e.g. infections, preeclampsia
Early labor or NICU visits
Unexpected health complications: e.g. positive screening for trisomy 21 or 18, car accidents

Not every traumatic experience leads to PTSD. There are many components that can influence your healing. Having resiliency factors (e.g. coping strategies, support from loved ones) can greatly improve how you process and move forward from this experience. Having a relatively safe life and limited trauma prior to this event can help us trust that the world is a safe place once again.

Depending on whether the traumatic event was a one time incident (e.g. mugging) versus a repeated event (e.g. ongoing civil war) can impact your healing. When it’s a one time event, our system is better able to see the situation as an anomaly. When there are repeated infractions, we struggle to see the world as a safe and predictable place, and there is increased risk for PTSD.

During a traumatic event:

PTSD versus trauma. what to do after a traumatic event. how to recover from trauma. Kasi Shan therapy: online counselling. Kitchener, Ontario

During a traumatic situation, our survival system kicks in automatically. We are outside of our window of tolerance because this event was unexpected, and our nervous system is experiencing a threat to our well-being. Without conscious effort, our traumatized mind shifts to a state of flight, fight or freeze. We try and escape the situation as quickly as possible, or we try and attack and fight our way forward. If neither option works, we fall into a state of shock or freeze response. When safety is returned, most of us can calm down. However, for traumatized individuals, it’s like their mind is still hooked in that place of danger, and they continue to respond in a flight, fight or freeze manner.

Symptoms of Trauma

A traumatized individual will show symptoms such as:

What should I do about trauma? Being aware of PTSD. Kasi Shan Therapy. Online therapy. Counselling in Kitchener, Ontario

Hypervigilance: a need to assess for constant threat. This involves a high degree of alertness for anything related to the disturbing event.
Reliving the traumatic event: e.g. through flashbacks, memories, dreams or intrusive thoughts
Avoiding reminders of the disturbing event: this can involve avoiding even the most basic connection. For example, a mother with birth trauma may avoid going to hospitals or visiting medical professionals. She may refuse to talk about her birth experience or listen to others’ birth stories. In the hardest of scenarios, she may avoid any interactions with her newborn.
Increase in negative thoughts and feelings: e.g. numbness, guilt, shame, anxiety, irritability, hopelessness. The traumatized person often feels the world is unsafe or unfair. He or she may be cautious about trusting others.
Hyperarousal: Feeling on edge, jittery, difficulty relaxing
Dissociation or impaired memory recall: In some cases, the individual may forget parts of the trauma, or have blocked out this entire event.

Usually, we experience these symptoms right after a traumatic event; however, some individuals have a delayed onset.

When is it “normal” and when is it PTSD?

Posttraumatic stress disorder. What does it mean, and how do you get help? Kasi Shan Therapy. Online support. Kitchener, ON

The majority of us have survived a traumatic situation. In the beginning, we feel jittery, hyperalert, and avoidant. This is normal. There are parts of our system that are scared of a similar event happening again. In order to ensure safety, these parts will assess for danger and remain hypervigilant of repeat offences. During this time, you will likely experience a lot of distress. However, trauma symptoms tend to dissipate on their own within a month without any major influence. Short-term therapies, medication, and support from loved ones are effective tools that can help with this transition.

In order to have a diagnosis of PTSD, you must experience continue to experience trauma symptoms a month after the traumatic event. These symptoms may last for months or years following, and they cause significant impairment in the person’s daily life and relationships. If you are concerned about experiencing, PTSD, you can take the Posttraumatic Stress Disorder Checklist (PCL-5) as a self-assessment. Any scores approaching 40 warrant a conversation with your family doctor or a mental health professional.

What can I do if I still feel traumatized after a month?

I encourage you to seek therapy as soon as you feel ready to process the traumatic event. While counselling is not meant to be triggering, it can be hard to revisit a difficult memory. If you feel too overwhelmed to even think about the traumatic incident, your system may benefit from extra support to manage this anxiety first. This may involve medication, or specific counselling strategies focusing on distress management.

There are many different counselling approaches that can be used to process traumatic events. Some well known options include: include cognitive processing therapy, sensorimotor psychotherapy and narrative therapies. The following three options are services that can be provided via Kasi Shan Therapy.

Eye movement Desensitization and Reprocessing (EMDR)

EMDR. Eye movement desensitization and reprocessing. treating traumatic events. Kasi Shan Therapy. Counselling in Kitchener, ON and online.

EMDR is a powerful approach that divides a traumatic experience into smaller, manageable chunks to slowly process each part of the incident. Typically, the work starts with either the first or worst part of the memory, depending on what feels manageable for you. In EMDR therapy, we use a process called bilateral stimulation to help process traumatic memories (learn more about how EMDR works). IN EMDR, with each passing of bilateral stimulation, the traumatized individual starts to feel some distance from the traumatic event. The event feels less personal, and there is a continued lowering of distress level. An individual quickly moves from negative beliefs and high distress to more positive beliefs about themselves, less fear when thinking of the memory, and calmness in the body.

EMDR does not require you to go into specifics of a traumatic event. Instead, clients can express barebone details aloud while still making sense of a unpredictable and nonsensical event. This can feel helpful for those who are not ready to speak about the traumatic event in detail as of yet. In fact, for those who do get stuck in the narrative of a traumatic event, your therapist will keep checking that you are properly processing a memory versus getting retriggered.

Cognitive therapies and prolonged exposure

When it comes to traumatic events, we form negative beliefs about ourselves and about the world. Cognitive therapies help us challenge these beliefs by assessing their validity. We look at whether our assumptions about the world, others, and ourselves are fair and consistent. The therapist and client works to start formulating more neutral or balanced thoughts.

In addition, many therapists will encourage clients to practice in some form of exposure therapy. With trauma, there is a lot of avoidance of the traumatic event. Prolonged exposure involves slowly approaching the activities or individuals that remind us of the traumatic event. This is done at a gradual pace in order to not overwhelm the system, and to help build confidence in our capacity to manage distress and test out problematic beliefs.

Internal Family Systems Therapy (IFS)

IFS recognizes that our system can become divided following a traumatic event. There are parts of us that carry the wound of a traumatic event. We often bury or push this part away from our awareness. These exiled parts typically carry a lot of shame, guilt, fear or overwhelm. Because they are so overwhelming, we have other protective parts that compensate. We have proactive parts that prevent us from triggering these wounds. We also have reactive parts that respond when we are triggered trying to manage the intensity of these exiled emotions.

For example, following a miscarriage, we may have an exiled part of us that believes we are responsible for the pregnancy not lasting. Because this is such a painful burden to carry, we may have proactive parts that do not let us get pregnant again, cancel IVF appointments, or push fights with our partner to prevent intimacy. If another miscarriage occurs, we may have reactive parts that become extremely angry at ourselves or our partners. This part may lash out through verbal attacks, or may cause physical harm onto our own bodies in order to deal with the pain.

In using IFS to treat trauma, we have to work with all parts of your system. Rather than diving straight into addressing the wound, we work with these protective layers first. We focus on building trust and safety with these protective parts. When they have relaxed, we then start to work with the core traumatic wound.

Reach Out

You may notice signs of healing within the first month, and not require additional support. However, if it’s been longer than a month and you continue to express traumatic symptoms, interventions can be helpful. Trauma and PTSD do not have to be a life sentence, and there are ways to help your recovery. If you or a loved one is struggling after a traumatic experience, reach out.

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.

Mental Health · Trauma

Working with unwanted feelings

March 15, 2021July 20, 2022 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

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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

Mental Health · Trauma

Why am I feeling stuck in my trauma?

February 1, 2021July 20, 2022 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.

Feeling stuck in trauma, therapy. Internal family systems therapy

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

Mental Health

Changing our relationship with our Inner Critic

September 14, 2020August 18, 2022 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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