House to home

For women who grew up in abusive/neglectful households...I encourage you to make your home now really feel like a home. It doesn't take a ton of money to surround yourself in comfort and beauty. Take time time...you're worth it and it's safe now...
and if it's not safe get the support you deserve to make it safe. You're worth it.

Healing Birth Trauma

http://hencigoer.com/downloads/cruelty_maternity_wards.pdf



Warning: the above article is very triggering for birth trauma.
I’m not even sure where to start after reading this article. First of all, I want to be clear that as a professional I am not interested in crucifying every person out there who is a medical doctor. I know there are wonderful medical doctors who deeply care about women and want to serve their patients with the best most respectful care. I also want to acknowledge that it’s the SYSTEM that seems to be sick and that very system seems to also traumatize good doctors, midwives, doulas, and lactation consultants. I have had many conversations with my own clients and friends who provide women’s health care that are so frustrated by how broken the system was they suffer vicarious trauma and burnout. But that’s another post.
The debate about whether childbirth can cause PTSD or medical interventions used in an intrusive way are abuse or not is irrelevant to me. Clearly there is a history of women suffering trauma in these situations and that is not theoretical, those symptoms are real. I am interested in making sure these women get TREATMENT so they can go on and bond with their babies as deeply as possible and choose whether or not to have more babies without the intrusive symptoms of PTSD getting in the way. I want fathers and partners to be able to concentrate on supporting the mom and getting to know the new baby, not having to be on high alert to protect the best interests of his new family.
Symptoms of PTSD can include:
-Experiencing an event where you felt your life or the life of somebody else’s was in danger and you were helpless to do anything about the situation.
-Intrusive memories of the event also known as flashbacks.
-Efforts to avoid anything that might remind you of the distressing event.
-Difficulty feeling close to your baby or other loved ones.
-Nightmares
PTSD is real. PTSD is treatable. PTSD is probably very under recognized in new moms for many reasons that need to be fixed, but if you see yourself in the above symptoms please consider getting help. Talk to a counselor familiar with PTSD who believes childbirth or medical interventions can be traumatizing. If you have a supportive midwife or doctor talk to them. Talk to a supportive clergyperson or find a local or online support group through ICAN or www.solaceformothers.org.
When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women

The CDC says nearly 1 in 10 US adults depressed

This seems to me like it is practically an epidemic. I found this article so interesting:




http://pagingdrgupta.blogs.cnn.com/2010/10/01/cdc-nearly-1-in-10-u-s-adults-depressed/



The psychologist in the article noted that depression can cause and exacerbate chronic health conditions such as diabetes, and heart disease. I would add chronic pain and autoimmune disorders to this list. Also work, family, and relationships tend to suffer when somebody is depressed.



The good news? Depression is very treatable. There are many simple self-help lifestyle changes that can cause major improvements in mood. For example studies have shown 30 minutes of exercise 3-4 times per week can reduce symptoms of depression. Omega-3 fatty acids have a similar effect. And of course, counseling has been shown to help depression.



So don't suffer. The consequences of not treating depression are significant. Treatment is available even if you start out with exercise and nutritional remedies before moving towards counseling or medication. Get help and get out to enjoy your life.

Miserable or strong?

We either make ourselves miserable or we make ourselves strong.  The amount of work is the same.  -Carlos Castaneda

Facebook Fan Page

Hi, everyone,
Please check out my Facebook Fan Page for my "Healing Mommies" counseling practice.  I will, of course, still be blogging here!

Healing Mommies

PTSD in childbirth.

I recently saw this article in SALON.com:

http://www.salon.com/life/feature/2010/02/17/ptsd_in_childbirth

It says that around 9% of women meet the criteria for post traumatic stress disorder (PTSD) after childbirth. Trauma can look like:
-Intrusive memories that are upsetting about an event.
-An event where you felt helpless and horrified, feared for the life of yourself or another person.
-Efforts to avoid any triggers that might remind you of the event.
-Nightmares.

Please know that good treatments are available. EMDR is one, as is cognitive behavioral therapy. Don't let PTSD rob you of precious moments bonding with your baby. The author says that PTSD never goes away and that's not true, it can be resolved or at least improved for most people. It is not unusual for somebody with a history of PTSD to have it re-triggered with a new traumatic event. For example, a childhood sexual abuse survivor whose trauma is resolved as a young adult might find it re-opened after a traumatic event in adulthood like a traumatic birth experience. This does not mean that you are weak or back at "square one." This means that you already have many of the skills needed to get through the trauma and you deserve support. Talk to a counselor, your midwife or doctor, or find free local support groups for postpartum women. There are also online forums, such as www.solaceformothers.org where you can talk to other moms, or use their warm line for support.

Advice to new moms

I saw this great video on motherhood:

http://www.youtube.com/watch?v=taDqKWWPDAY&feature=player_embedded

My favorite quote? "YOU are the expert." Yes, new moms, YOU are the expert.

Why "Healing Mommies?"

WHY “HEALING MOMMIES”
The answer isn’t because I work with women of childbearing age. A big part of my childbirth advocacy and interest in counseling for women during pregnancy and the childbearing years came from experiences at my last job, a job working with seniors. I have taken composites of several people (yes I heard different variants of this story several times) to put together this article, and all details are changed in order to protect confidentiality, but after reading this I think you will get what I’m talking about.
At my last job I worked with seniors. My job was to go to a senior’s home, do an assessment to see what type of services they needed, and provide them with a free peer counselor if applicable. Alice was in her early 80s, from the Midwest and had moved here after her second husband died to be near her adult sons. She was close with her sons but they said she seemed depressed and were concerned, so they contacted our program and out I went.
Alice was exactly what my stereotype of a Midwestern woman would be-sturdy, no-nonsense, sparkling eyes and pretty smile. Her senior apartment was tidy and comfortable with pictures of children, grandchildren, and husband all around. I expected to ask questions and get answers about grief over losing her spouse of 30+ years, sadness about missing her friends from back home after her move and frustration about current health problems but what I got was eye-opening and life changing for me. As I questioned Alice I found that yes she was sad and missed her husband, her friends and her health troubles were on her mind but something very different was causing her melancholy.
Very haltingly Alice told me about a baby she lost when she was in her 20s. This was her first pregnancy. Alice had grown up on a farm, the eldest of 12 siblings so she had no fluffy illusions about childbirth. She knew it would be hard but she had always looked forward to being a mother. The birth had been very difficult. But she had not expected to be kept from her husband and be left alone to labor for hours by herself. She had not expected to be strapped to a bed or shamed by one of the nurses for making noise during birth. She had not expected her movements to be restricted or to be given medications that she was told nothing about. Sadly, at some point during the labor her baby died.
After Alice had labored alone and feeling as if she was treated like less than a person, her requests to hold her baby in her arms before it was removed from the room were completely denied, a nurse telling her, “It’s best this way.” Alice sobbed as she told me this story, going from an 80 year-old grandmother to a young mother whose grief at losing her much hoped for infant was as fresh as the day that it happened. Alice had carried this burden for 60 years, alone and too ashamed to tell anybody. Alice felt guilty and wondered if she had done something wrong or if one of the medicines had caused her baby to die. Alice felt ashamed that she had wanted to hold her little boy and tell her goodbye. She asked me not to tell her sons, as they hadn’t even told her other surviving children that they had an older brother that had died during birth, and said she felt like there was something wrong with her that after so many years in spite of what her doctor and the nurses had told her she still felt grief over this loss.
While Alice was a wonderful mom and a devoted grandmother I couldn’t help but wonder if with her subsequent pregnancies if she felt more fear than joy, as she held her newborns if instead of satisfaction she felt a longing for her lost baby, if the minimization of her needs by the medical staff that were supposed to serve her had helped drive a wedge between her and her husband. To make matters worse social norms at the time (or now for that matter) also did not support a woman talking about losing a baby in this way.
But the task at hand was to attend to Alice. I held Alice’s hand as she cried and I had tears of my own in my eyes. My tears were about sadness and anger. I let her know that now hospitals “let” (even that term sort of gets me, as if hospitals have any ownership over what comes out of a woman’s body) women hold their babies if they wish, to take time to tell them goodbye and how healing it can be. I assured her it was a normal desire to want to have held her baby, to have told him goodbye, to have sang to him and said a prayer. She lost a child and deserved all of the social support that goes along with that, not the shame that she was given for wanting to hold her child, or the fear and isolation she was handed when she expected to be able to have her husband with her during the birth or to be able to move freely during her labor.
I asked her what it had felt like to hold her other babies in her arms when they were brand new and her tears melted into a look of bliss on her face. I assured her that even babies that die in childbirth are quite special to their moms and that holding them gives their mom a chance to say goodbye. I assured her there was nothing wrong for her desire to hold her boy and that in fact I thought this was a healthy thing. From a recent reading on the subject I told her that babies that are stillborn are beautiful to their moms, just still and quiet, and often moms are relieved to hold them and see how precious they are. She became quiet as I told her these things. I asked her what she would have said to him or would like to say to him today. I encouraged her to mark his birthday this year in a way that felt meaningful to her and we were able to identify a friend that she felt would be a supportive witness to this process. Subsequent healthy pregnancies had not made her forget this little boy and she still remembered his birthday and the trauma and grief of his loss quite clearly.
I selected a counselor who had also lost a child and who had counseled other parents that had lost children and would honor this woman’s grief in a way that would be healing. I left the building sad and angry. I know that as far as we have gone with women’s rights that our rights when it comes to the medical support we get during pregnancy and labor have more to do with what’s easiest and most convenient for people other than the mother. I know that many hospital “policies” are contrary to what science shows is what is healthiest and best for moms and babies-not to mention contrary to what women want. I hear from young obstetricians and midwives how hard it is to practice in a way that is loving and supportive towards their patients in a world full of lawsuits and antiquated patriarchal hospital policies. I hear from more seasoned veterans of women’s health that they are burned out from fighting an uphill battle for what is best for women and babies that they get out of working in obstetrics at all. I know that while we’ve come a long way, baby, we still have a hell of a long way to go.
Part of my practice is around helping women with grief after the loss of a child. I am also dedicated to helping new moms deal with feelings of anxiety and confusion if they don’t have (healthy) moms of their own; work with trauma after a difficult birth or a sick baby; or helping sexual abuse survivors go through pregnancy in a way that feels safe and comfortable. While I wasn’t around to help Alice I hope I can help other women get the help they need in time to feel as connected as possible to their other kids and not be too hindered by grief.

What the heck is a doula?

I have heard a lot of confusion before about this term and what the role of a true doula is. I have heard people think a doula is the same as a midwife (no), that doulas assist with deliveries (sort of but not in the way you think), that you don't need one if you have a husband/partner there to help (but what if your partner needs one?) and that you can only have an unmedicated natural childbirth with a doula.
Well, let me address some of these questions. A doula is a trained support person (usually a woman) that is there during labor and delivery to support both the mother AND her partner. Doulas are trained in assisting with non-medical comfort measures, psychological and emotional calming and support for the parents, and to act as an advocate for the mom and partner if the need should arise. Research shows that women who have doulas present during labor and delivery have less need for medications, less dystocia, and fewer c-sections (from www.dona.org). Hospitals are beginning to realize that doulas address a crucial part of the laboring mother-her emotional and psychological comfort-that hospital personnel aren't always set up or able to provide care for.
Doulas don't take the place of a husband or partner but rather help him provide the most effective support for the mother and spell him when he needs a break. Doulas don't force moms into making choices about epidurals or interventions, but help a mother educate herself on these interventions and support her choices whenever possible.
For more info on doulas go to:
www.dona.org
or read:

Emotional reasoning and should statements

Two more cognitive distortions are emotional reasoning and should statements. Here are some examples:
“I feel so guilty about being sick, I must deserve being ill.”
In emotional reasoning we take our feelings as facts. In the example above the person feels guilty so she rationalizes that she must deserve being sick. Often our feelings are intense, uncomfortable, and pervasive but feelings are not always facts. A more rational example might be:
“I feel so guilty about being sick but I know that I am doing the best that I can.”
An example of a should statement is:
“I should be able to keep up with other people my age in going to both school and work. “ In this situation the person is irrationally blaming herself for having limits due to a very real illness. A more rational statement would be:
“I will do the best I can and fit my lifestyle around what is realistic and healthy for my limits.”
I know so many of these seem like basic ways to tweak your thoughts but it’s amazing how these negative thoughts can pile up and affect our mood and health. I hope you’re following along, picking out your statements and finding ways you can be healthier and more realistic with yourself!
‘Til next time!

Healing Mommies

Healing Mommies is a subset of my practice dedicated to helping women with the unique issues that pregnancy and motherhood can bring up. Pregnancy and motherhood is supposed to be a joyous time but for some women it brings up feelings of fear, loss, anxiety, and doubt. For example:
• If your mom was absent physically or emotionally as you were growing up due to mental illness, jail, alcohol or drug abuse.
• A mother that was abusive or was unable to protect you from abuse.
• Sexual abuse survivors often feel out of control or anxious during pregnancy and lactation due to their changing body and the potential of medical intrusion.
• Women who have lost their moms at a young age.
In these situations and similar situations women feel anxious about their ability to mother, memories of abuse can re-surface, or the grief of losing your mom can come back once you begin to mother. These feelings are normal and with proper help most women can get relief. Addressing these feelings can allow you to better bond with your baby or child, feel more comfortable during pregnancy and labor, and reduce chances of postpartum depression or trauma. It’s my belief that happier moms = happier babies = happier families = happier communities. So taking care of yourself is really a very self-less thing to do! I offer a $10 new family discount for pregnant moms and families with children under the age of two. Please watch my website www.lindseyplumer.com and blog for more updates.

"She said yes...now what?"

“She said yes…now what?”

I want to thank Jackie Belau aka the Maternity Maven for a fantastic networking event where I finally got to meet some awesome care providers and businesses that cater to women, pregnant moms, little kids, and families in the Sacramento/Placer county area. Many of these care providers are midwives and doulas who routinely ask their clients about a history of trauma whether it be childhood abuse or adult abuse. 99.99% of the time I hear that the midwives, doulas, and OBs do a good job at following up when a history of trauma is indicated by a woman in their practice, but I wanted to write this as some reassurance and suggestions and reminders about how to proceed.
First of all asking and truly listening to the response can be a very healing moment for somebody that has been through abuse. By not treating that moment as another box to check off and really actively listening you are providing unconditional positive regard and support. That can be healing in and of itself. But beyond that what are some specific things that caregivers can provide?
Ask the woman where she is in her healing process. Note that I didn’t call her a victim or ask if she had been in therapy. Not all women feel like victims or even need therapy. Some women are in denial about the effect that the abuse has had on them and starting off by using words like victim or automatically referring to therapy can push her further down the path of denial or traumatize her. Moving through abuse is truly a healing process that can take on many facets and it is important to acknowledge that there are a wide range of responses to being abused.
If a woman is struggling help her identify resources in her life. These resources could range from family and friends, a spouse or partner, a counselor, a spiritual advisor, even pets and coping skills such as journaling.
Know as a provider that it is not unusual for feelings that were thought to be resolved to re-emerge as any survivor goes through developmental milestones. Milestones such as pregnancy and children are no different. This doesn’t mean that a client is “back at square one” or there is something wrong with them. In my experience as a person evolves her understanding of significant life events also has to evolve. If those life events are very difficult ones she may need a bit of additional work or support but because she has “been there, done that” with her abuse history she will already have coping tools she can use.
Ask your client if any counseling that she had in the past was helpful or not. It isn’t always helpful. Sometimes the fit between counselor/client isn’t right or the timing is off for a woman to fully process her issues. Ask her what was helpful and what was not helpful and take the time to truly listen, as this answer will give you vital information about what the woman needs right now and how you can help her get there. Have referrals available if your client chooses counseling. Make sure the referrals are trustworthy and have some ideas about a variety of sliding fee clinics if necessary. Feel free to contact me for specific suggestions on this.
Remind her that the healthier she is the better start she can give her babies, her children, her partnership, her marriage, everything. Many women feel they are too busy to re-visit these issues and that they are selfish for “indulging” in the time and money it takes to fully process a history that has come and gone. A happier mom means a happier baby, a healthier attachment for mom and baby, a healthier attachment between father and baby, a healthier family unit and I dare say that that lays the foundation for a healthier community and world. I can’t think of a better investment of time or money. Pregnancy is a time that I refer to as “emotionally porous.” So while we absolutely work with our clients to “do no harm” and provide a safe space for them to create a new life remember that we can also plant seeds of well-being and healing that can take root and blossom.

Feelings...nothing more than feelings...

The next two cognitive distortions I would like to look at are “Jumping to conclusions” and “Magnification/Minimization.” Each of these distortions has subtypes. “Jumping to conclusions” has the subtypes of mind reading and fortune telling. “Magnification/Minimization” has the subtype of catastrophizing.
An example of jumping to conclusions and mind reading would be:
“I called in sick to work twice this week because of my pain. My co-workers must think I’m lazy and hate me for having to pick up the slack.”
A thought that might be more rational and healthier would be, “I will let my boss know the chronic nature of my illness and find out what I can do so I can do my share. I will also check in with my co-workers to ensure that I can cover what I missed.”
For fortune telling the thought might go along the lines of:
“I will lose my job for sure if I keep calling in sick!” Think about the feelings this thought would bring up. Anger at your body, fear of the future and for your income, helplessness over the situation.
A healthier thought would look like, “I will communicate with my boss to see what I can do to preserve my job, including getting a doctor’s note for accommodations if need be.” A thought like this is just as rational and real as the last thought, but gives the individual power and hope.
Magnification looks like this:
“This is the worst pain ever. Everyone else is out living their lives and being healthy and I am stuck at home and in pain.”
Well….actually there are lots of people out there with varying degrees of difficulty, pain and strife that they are dealing with. A thought like this can make a person feel physically worse and helpless. A healthier thought might be:
“This is difficult but I know I’m not the only human being who deals with adversity. I will also focus on positive things going on in my life right now such as….”
Many of these distortions are so automatic we don’t even challenge them as the truth when in fact they are not completely true. When we look at these distortions in a more balanced life we free ourselves from a self-imposed set of limitations and allow for more hope, health, and healing in our bodies and lives.
Here is a wonderful book from one of the founding fathers of cognitive behavioral therapy:

Disqualifying the positive and knowing when to get professional help

The next cognitive distortion I would like to examine is "disqualifying the positive." This one is an easy trap to fall into. For example, if you had 10 tasks to do in a day and did 8 of them perfectly and 2 you had a tough time with you don't go home and think about the 8 ones you accomplished with ease, you obsess on the 2 that were difficult. An example of disqualifying the positive when it comes to coping with chronic pain would be:

"I have felt awful for the past week. It is awful living with fibromyalgia!"

Well, yes, living with fibromyalgia is really unfun at times. But a statement that would be just as accurate and more helpful to your ability to cope would be:

"I have felt awful for the past week but thankfully for four weeks prior to that I felt fantastic and it feels as if I am coming out of this flare-up. All of my flare-ups have passed at some point and this one will too."

See the difference? By looking at the big picture you give equal weight to all facts-including the fact that the days where you feel good are just as valid as the days you don't. This isn't being pollyanna-ish it is being rational. Through this rationality we can improve our ability to cope with pain and not allow it to rule our lives.

So...obviously this blog is not a substitute for professional, individualized mental health help. How do you know it's time to seek help? If you are suicidal immediately get help via an emergency room or doctor's visit. That aside, if your significant life activities are hampered by your mood it is time to get help. If it is tough to get out of bed, go to work, enjoy your relationships and hobbies due to your mood it's time to invest in yourself.

A good self-help book for depression:

A mindbody connection to pain?

I wanted to take a little pause in the CBT series to examine a theory that addresses chronic pain. Dr. John Sarno is a professor of clinical rehabilitation medicine in New York. Dr. Sarno has written several books based on his successful cures of back and other chronic pain that he calls Tension Myositis Syndrome. Dr. Sarno believes, based on his work, that many chronic ailments are due to repressed feelings of rage and sadness. He does not suggest that these chronic pain problems are "in the mind" but says that they are very real and that the mind and body cannot he separated. Dr. Sarno's program involves first ruling out any physical acute diagnosis and then partaking in a workshop designed to help people express repressed feelings and educate individuals about this link. I have read two of his books and I admit he makes a very strong case. Either way it is important for people with chronic pain to examine their emotions and express them in a healthy way because this facilitates a reduction in pain. To find out more check out:



and

Coping with Chronic Pain-More Cognitive Distortions

Two more cognitive distortions I would like to discuss are "Overgeneralization" and "mental filter."

With overgeneralization people take a few instances of a certain outcome and use those instances to make wide generalizations about how life is. For example:
"That doctor wasn't empathetic or helpful. No doctor will be able to help me! It's useless to keep going back for appointments!"

A more helpful, rational statement might be something like, "That doctor wasn't very helpful. I will either make another appointment with that doctor and try again or get a referral for a second (or third) opinion until I find a doctor that I am comfortable with. My well-being is worth putting out the time and effort."

Mental filter is the next cognitive distortion I would like to discuss. With mental filter we focus on negative aspects of an event or situation while ignoring the other equally valid aspects of the event. This is like a single drop of ink tainting an entire glass of water.

An example of a mental filter distortion would be, "I had a fibro pain flare-up and I was in pain at my grandson's birthday party. The whole thing was ruined!"

A healthier, more self-preserving belief would be, "It's too bad I had to leave right after the cake was cut due to my pain, but it was so great to give my grandson a big hug and see his face light up when he opened presents. It wasn't perfect but I was glad to be there."

A person emailed me privately regarding this series and asked in essence how to adjust to a new life with chronic pain or illness after the "old" you is gone. This sort of depends on many factors but using a cognitive distortions perspective, I would encourage that person to explore what distortion is causing the most distress. For example-if you lose a bunch of weight you are no longer the "old" you but this situation is a happy, exciting one.

I would guess that there would be some all-or-nothing or mental filter distortions going on. For example,
"I was always happy before and I will never feel that way again." or
"I have a very miserable life since my diagnosis. I don't see an end to this."

More helpful and just as real thoughts would be,
"I had challenges before that took time and adjustment to learn to cope with. I will learn to cope with my pain until I can rid myself of it."
or
"I still have some great things in my life-a loving partner, good friends."

A great self-help book that is along the lines of cognitive therapy is:
Loving What Is: Four Questions That Can Change Your Life

As always this blog does not substitute the real, in person therapy that a trained doctor or mental health clinician can provide. If you are currently suicidal please call 911 or go to the nearest emergency room.

Coping with Chronic Pain-The first of a series

Many people live their lives in a silent day-to-day struggle. Right now it may be your friend, family member, or co-worker who is dealing with a diagnosis that causes chronic pain. These disorders can run from rheumatoid arthritis, back pain, fibromyalgia, migraines, or one of several chronic pelvic pain disorders such as vulvodynia, vestibulitis, or endometriosis. Some of these disorders share some common traits.

Most of these problems are known as invisible disabilities. An invisible disability is not obvious to the naked eye. The person looks healthy and yet they call in sick to work or school a lot, can't work at all or only minimally, and have difficulties in their relationships but because they appear normal people around them might pass judgment unfairly about why the person isn't working, going to school, or passing up on social invites. Many of these disorders are poorly understood not just by the public at large but also by the medical community. With vulvodynia (chronic horrible unremitting vulvar pain), for example, the average woman sees eight doctors before she receives a diagnosis. Even after a diagnosis is made many doctors who are so called specialists understand very little about how to provide relief so it can take months or years of trying different treatment or switching doctors to get relief. Additionally pain management is very poorly understood by many physicians. Because of this doctors can be reluctant to provide pain medications or even a referral to a pain management specialist despite evidence that pain medicine can vastly improve a person's quality of life and a person who is actually in pain is at a low risk for abusing pain meds.

To make matters more difficult more women than men suffer from chronic pain. This is little comfort to the men out there who are trying to cope with a chronic pain disorder. However, for many years women in chronic pain were dismissed or stigmatized by the medical community as being "hysterical" or that the pain is "all in her head" or she was "frigid" and needed to "loosen up a little." These attitudes are unfortunately still found all too easily in doctor's offices across the country, and most women who find a good doctor who is both compassionate AND competent knows that doctor is like gold. So thank you to all of you doctors, NPs, PAs, and clinicians who are both compassionate and competent.

I am going to use this series to go over some cognitive distortions that can make the emotional and relationship of pain disorders worse. I am also going to discuss how therapy can be of help and also discuss alternative therapies that you might not know about that might also offer you some emotional or even physical relief. I will go over how to make your own "emergency list" of coping tools of what to do in a pain flare-up so you can feel as if you have some control over your life. And hopefully through this I can encourage you to keep trying treatments and coping skills until you feel as if you get your life back or your pain disorder goes into remission-it does happen!

One of the best known psychotherapeutic techniques to help people who are suffering from chronic pain is cognitive behavioral therapy also known as CBT. CBT is also used to help people deal with depression, anxiety, trauma, and relationship issues. For the purpose of this series I will give examples that relate to chronic pain. There are ten common cognitive distortions and I will discuss a few per blog over the next several weeks. I encourage you, the reader, to journal about the distortion and examine your life to see if or where you are using any of these distortions in a way that is harmful to your well-being and I challenge you to substitute the distortion with more rational, healthy thoughts.

The first distortion I would like to discuss is called "All or nothing thinking." This distortion can contribute to depression and anxiety, thus making your pain physically feel worse AND having a devastating effect on your emotional well-being. It is true that somebody who is depressed or anxious about chronic pain actually experiences that pain more acutely. A clue that you are getting tripped up with all or nothing thinking is words such as "always" "never" or "ever." There are very few situations in life that are all-or-nothing.

A few examples of all-or-nothing thoughts are:
1. I will never feel better again.
2. This pain flare up will never end. I just can't cope.
3. I will always feel horrible.
4. I will never be able to work full-time because of this.
5. Nobody will ever love me if I am always sick (wow-there's TWO distortions for the price of one there!).

Some healthier examples of thoughts that are also true and more advantagous to coping are:

1. I may feel better again. After all, I have some days where I don't feel so well and some days where I feel fine. I can learn to ride out the ups and downs and be easy on myself when I am not feeling well.
2. Most of my pain flare-ups last six or seven days (or a month, etc. It is important to track your pain so you know what the REAL answer is to this question). Even if I am in daily pain some days are better than others. I have a list of coping tools that I can use to help make flare-ups more bearable such as relaxation, massage, acupuncture, and pain medications.
3. Many people who have chronic pain find some type of relief-even if it takes years. I will be one of those people and I will continue to plug away at this because my well-being and comfort is worth it.
4. It is ok to find a flexible or part-time job that will accommodate my health because my health is a priority. I will explore options such as job-sharing, self-employment, work from home, and even disability so I can remain self-sufficient. Because I'm not a fortune teller I don't know for sure that I will NEVER be able to work the future may hold physical relief or a job that fits my situation.
5. The vows of "in sickness and in health" also apply to me. I deserve to find somebody who is compassionate and mature enough to understand and be supportive of my limitations. Everybody comes to a relationship with baggage-it may be a chronic pain issue, a mental illness, a crazy family, or an annoyingly quirky love of stamp collecting. Just as I will be loving an accepting of my partner's quirks I expect my partner to work with me with mine.

These healthy thoughts in no way are meant to minimize the difficulties of living with pain. It is depressing, anxiety producing, angering, and upsetting to be in pain. But cognitive distortions don't serve us and taking an honest look at which ones we may be self-harming with help us break out of patterns of depressive or anxious thoughts and move forward to feel better both physically and emotionally.
Next entry will cover a few more cognitive distortions. Here are a few books/CDs that I think are helpful for coping:

Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now

Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach Workbook (Treatments That Work)

The Mindbody Prescription: Healing the Body, Healing the Pain

Suggested Reading Material

Much like my suggestions to almost every client to exercise regularly, there are a few "tried and true" book suggestions I have that I find myself making over and over again.  Whether you are in therapy now with me or somebody else, you are considering therapy, or you would just like some decent self-help books here are some that I find incredibly valuable.

A few general self-help books for anxiety and depression:





 
The next one is a favorite not just because it's so good but because the title is fantastic.  Definitely remove this one from your coffee table before any family gatherings...



 
Incredibly helpful as an assist to couples therapy or for couples to try working thru on their own to increase their communication skills:
 




Fabulous depression self-help book:



Wonderful book for sexual abuse survivors as they prepare for pregnancy, birth, postpartum and lactation written by my mentor Phyllis Klaus:



For clients who are living with chronic pain this book has solid treatment options along with holistic support:



My favorite parenting book in the whole world:

Happy Birthday to The Birth Center

This weekend the Birth Center (http://www.sactobirth.com/), Sacramento county's ONLY freestanding midwife owned and operated birth center celebrated its Birth Day! They recently moved to a new location on Laurel Hills Drive and with the move they were able to open The Nursing Nook: http://www.thenursingnook.com/ CONGRATULATIONS!!!!
For women who are sexual abuse survivors pregnancy, labor, delivery, and the postpartum period can be a vulnerable and EMPOWERING time. Choose your attendant carefully. This means if your OB or midwife doesn't feel right interview more, hire a doula, and get training in relaxation techniques. Sorry to say the brief minutes spent on relaxation breathing during a hospital's general l&d class are woefully inadequate to prepare any woman for birth and should be considered an introduction and not a full preparation education. Looking into Hypnosis, Bradley, or Lamaze classes in order to have the best experience possible.
For sexual abuse survivors being pregnant can open up fears about your body, trust, sexuality, and vulnerability that are reminiscent of being abused. Talk about your feelings with a trusted therapist, your midwife or doctor, or clergy person. Use the time that your body is growing and changing to learn to trust yourself again and restore faith in your body's awesome abilities. Do not tolerate further intrusions in the form of medical interventions if they are unnecessary and don't feel right. If your midwife or doctor treats you like a child or an unequal participant you have the right to find a care provider that is more competently able to provide services. You deserve a care provider who is as compassionate as they are competent.
One of the most fabulous, normalizing books I found about childbirth and pregnancy was this one:
"The Complete Book of Pregnancy and Childbirth" by Sheila Kitzinger
Good luck and happy deliveries...

How much do you want it?

I started to write this geared towards other mental health professionals and marketing but then I realized...this topic is applicable to EVERYONE. Read on for more info.
When I was little my mom had a friend named Thelma. She was so funny and great with kids. Sometimes when I would ask her for something (a drink, a snack, etc.) she would say "How much do you want it?" or "What's it worth to you?" I was reminded of this recently on an online forum for therapists where the topic was marketing. Some therapists were remarking they had been in practice for months with few or no clients. When asked their list of marketing activities seemed spotty at best. No websites, few regular networking or marketing activities. I wanted to ask them, "How much do you want a full private practice?"
When I went into practice I wanted to go full-time. I was told by MANY people, "Nobody can do that, you should have another part-time job, it takes YEARS to build up a client base." Within 6 months I was almost full. Within a year I was so busy I had to turn clients away. But I wanted to be a private practice therapist really bad. So in sheer desperation I did the right thing and worked REALLY HARD.
I wanted to work 40 hours per week so when I wasn't seeing clients or doing paperwork I was marketing and networking for the full 40 hours per week. No marketing job was too big or small. My website, advertisements, search engine optimization all got put up almost immediately and then re-worked based on what worked or didn't work. I contacted everyone in my palm pilot and email book and let them know I was accepting clients. A few weeks later I contacted them again. I met professionals that I found online that I thought would have businesses that complimented my practice and met them for lunch or coffee. I sent thank yous for referrals. I made up spreadsheets to track the success or failure of marketing efforts (postcards, articles written, Internet listings all got noted). I brainstormed new marketing projects and started at the top and worked my way through them one by one. A few months later I noticed my 40 hours was filled with clients and not marketing activities. I was on my way.
So what does this have to do with the average person? Do you have a goal that you find yourself dreaming about? Weight loss, running a marathon, fixing up your home, being a better parent or improving your marriage? Let me ask you how much do you want to achieve that goal and how much time are you willing to put into it? What are you willing to do to change your life for the better? The marathon runner doesn't get up one morning and just go run a race. They spend time every day running. If you want to improve your marriage, reduce anxiety, lose weight, whatever it takes effort on a daily basis.
I know this is a gross oversimplification but sometimes it's not a bad idea to just start changing your life by making a daily effort and see how far you can go.