Health Maintenance

In order to be in social work for the long haul, I have become deeply committed to self-care in the intense way that I do everything.

I exercise daily.

I take supplements (salmon oil, b vitamins, etc.) and prescribed medication.

I eat a lot better - protein shakes to replace meals regularly, more fruit and veggies, salads, water, nuts instead of chips, cottage cheese with pineapple instead of ice cream, watermelon instead of pastries, etc.

But one of my favorite new self-care regimens is monthly massage.  I have come back to this tried and true method of releasing accumulated toxins and feeling downright yummy.

There is a spa in Pasadena (you know the one) that offers a deal - $79 is charged to your account every month for a year in exchange for a 50-minute relaxation massage and use of their jacuzzi/steam room/sauna.  Since I don't buy morning lattes or designer shoes or drive a gas guzzler or have a car payment, I can well afford this health maintenance package.  In fact, when I go back to work full-time, I will bump up my monthly massages to weekly.  I think my face and joy will be a walking advertisement for massage.

I like interviewing massage therapists about how they manage to help release the toxins of others without taking them on.  This massage therapist said that she allows the toxins to go into the ground.  I asked, "but, how?"  She said that she visualizes energy coming through her via the crown of her head and the toxins being absorbed into the ground.  She appeared just as friendly, warm and energized after my massage as she had been before.  I can't always say that about myself after meeting with every client.  There is something there, I believe.  Something that social workers need to pay attention to and cultivate, beginning in graduate school.  I wish I had several lifetimes to pursue all my research interests.  

Whatever floats your wagon (I love mixing metaphors - such a faux pas), do it with relish.  Yes, you matter, so enjoy.

Harmonizing Mind-Body-Spirit

For the last two years I have been conducting a dangerous experiment:  How far can you stretch a girl before she breaks?

This experiment would not have made it past the Human Subjects Review Board.

The experiment is now happily suspended indefinitely.

What I learned along the way about coping is now coming in handy for others.

It is that time of the year - school has just started and people are already stressed.  I have been getting calls from people trying to cope.

Here is a list of what has worked for me.  This list is entirely subjective so please experiment with an open heart and mind.  For instance, I love, love, love acupressure but my husband went to the same guy and felt nothing.  On the other hand, my husband really vibed off our massage therapist-turned-acupuncturist and I did not.  So there you have it.  Have fun exploring healing practices that might work for you.

Please remember, as I learned (finally!), no matter how much you try to cope, there is a limit.  Take a step back and reflect on whether you have taken on more than you can chew.  Sometimes our eyes are bigger than our appetites and we have to say no to a project even if it seems really juicy.  There is time enough for it later if we take care of ourselves now.  Work up the courage and faith to make a big change if necessary, including changing your unrealistic expectations. Your spirit may be trying to tell you something with all that discomfort and dis-ease. By all means ask yourself, what do I really want? and trust your inner voice.

The List:

Prayer and/or meditation. Regular practice is key.

Supportive friends and/or family.  Regular contact with people rooting for you and who you can talk to about almost anything.

Eating well.  We have so many food allergies we are unaware of - listen to your body or go to the doctor to get tested.  Because of my gall bladder disease, I stay away from butter, cream and fat from red meat (I miss caldo de res, chorizo, and cream-based soups). If I eat these foods, my belly swells up six-months pregnant-style or I wake up in the middle of the night to a burning ring of fire around my torso.  Generally speaking, our bodies need and thrive on plant-based foods. Food is medicine.

Supplements & Medication.  Find a healer to help you find the combination that works for you. For me, high grade Salmon Oil, the Vitamin B series and Vitamin E (makes my eyelashes longer even) works.  Unfortunately, there is a lot of shame around taking medication for mental health. Please don't let that stop you from being well.  I know a lot of wonderful, intelligent and beautiful people who swear by it, including myself.

Sleeping well.  We need 8 hours.  Every night.  Insomnia is epidemic and you are not alone.  It is a sign that our mind-body-spirit is out of balance.  There is so much to do to address this.  Reach out to healers.  I like to try exercise, chamomile tea, a super dark room, a warm bath, counting my breaths, getting up in the middle of the night to write if I have a lot on my mind, George Lopez or the Pixies on my iPod, etc.  I talk more about hypnotherapy later but I found a free downloadable podcast at HypnosisDownloads.org to stop insomnia.

Exercise.  Do whatever seems fun and safe and do it often. I like to sweat it out at the gym as often as possible.  I like to blast a tennis ball weekly to channel my aggressive drive.  I like to dance whenever I can to move the spirit.  My massage therapist said I can naturally re-align my body through dancing - woot woot.  My shaman said I need to spend more time in nature, so I am taking it outside and adding hiking to the list of things I do to move my body.

Laughter.  Whatever it takes to make you laugh, baby.  Laughter releases the body's natural painkillers - really good medicine. Even if she doesn't get the joke, my daughter laughs when I laugh, enough said I think.

Sex.  Yes, energy for sex and sex for energy.  The more sex we have the longer we live - I would add the happier we are, too.  As long as it is mind-body-spirit safe.   Good medicine.

Forgiveness.  I went to a workshop at a local church about forgiveness. The speaker, Connie Domino, is a public health nurse who developed a curriculum for achieving your goals.  She found that some people got stuck and others bounded ahead.  She noted the least successful were bitter and resentful and the most successful were forgiving.  So now she teaches how to forgive.  She has a book, The Law of Forgiveness: Tap in to the positive power of forgiveness and attract good things to your life, with a great script for releasing people, dead or alive, with forgiveness. I heard Oprah quote that resentment and not forgiving someone is like drinking poison and expecting the other person to die.  Forgive and live.

Reading or Listening.  I love reading books, mostly non-fiction.  Okay! If you must know I have read a lot of self-help/self-improvement books.  I hate that the genre is stigmatized.  Cynics and hipsters, please look away now.  One of my favorites is, The Power of Positive Thinking by Norman Vincent Peale.  I really believe it is important to be selective about what we feed our brain.  What or who are we reading, listening to and letting in?  We have a choice.  It makes a difference.  I read a Children's Bible to my daughter at bedtime.  I learn something new every time I read the same stories over and over.  I love Paulo Coelho, Iyanla Vanzant, Napolean Hill, Martin Seligman, Emmy Werner, and so on.  Check out the recommended reading list on the right hand side of this blog.  The words of these wonderful spirits now live on in me because I have read them and internalized them.  Some lyrics have the same effect on me - Susana Baca, Tears for Fears, Bad (live) by U2, and many others stir the passion in my soul and make me feel bold or happy.  Or they help me to embrace sadness and pain before letting these feelings go.  I like singing and reading the hymns at church on Sunday mornings as well.  I like filling myself with good stuff.  Good stuff in - good stuff out.

Alcohol, marijuana and other drugs.  I know many people who use alcohol and other drugs to manage their emotions.  I have no judgments, I get it.  Personally, these methods don't work for me.  I don't have a strong taste for alcohol and I don't get a buzz, I get a headache.  One time I tried medical marijuana for stress and it gave me allergies.  When I was a kid in East Los Angeles, I participated in an after-school program called "Get High On Life" at Salazar Park.  We played, did crafts, went camping.  Hearing my daughter laugh, laughing at my husbands jokes, dancing to live music, watching fireworks at the Hollywood Bowl, playing tennis and so on - all these things give me a natural high.  If you are looking for alternatives to coping, please read on.

Hair, Face, Hands & Toes.  Getting your hair did, getting a facial or wax, getting a mani or pedi - it all feels like a getaway and love wrapped into one, especially if they throw in a massage.  Good stuff.  Sometimes you just want to leave work at lunch time and have someone wash your hair, like mama did when you were a baby.

Acupuncture.  I have gone for stress or body pain.  I know others who have gone for weight loss assistance and fertility issues.  I have a really good referral for this type of healing - email me if you are interested.

Acupressure. Wow, this cleared out a lot of stuck energy.  Sobbed for awhile.  Good stuff.  My acupressure guy moved away :(

Massage.  This has been really good for me after sports activity. If you tend toward being anxious/worried or have a high stress job (hello, social workers!), then this is good on a regular basis, say weekly or monthly.  I see a lot of sidewalk signs for $45 massage while driving on Fair Oaks, Wilshire Blvd., or Santa Monica Blvd.  I would say buyer beware.  Get referrals and experiment.  I have a great referral who charges $70 an hour and does home visits if you are in the Northeast Los Angeles area  - email me if you are interested.  I also have been to dtox spa in Atwater Village (a referral from Josh) and Burke Williams in Pasadena (I like going on a Friday night when I feel like I got the whole place to myself. Beware: bathing suit or birthday suit in the Jacuzzi?  I have seen both.  Wear whatever you are most comfortable in.)

Chiropractor.  Sometimes life throws me out of alignment.  I usually need to go to a chiropractor, massage therapist and acupuncturist all in the same week if I am really in a bad way - from structural to soft tissue repair.  I have a great referral in Silverlake.

Yoga.  A lot of research dollars have poured into testing this ancient spiritual healing practice.  So far the results are really good for anxiety, depression, arthritis, asthma, heart disease, and so on.  After the final resting pose, I feel as calm and relaxed as I do after a one hour massage.  $10 per yoga class if you can muster the energy to move the energy yourself or $45+ if all you can do is crawl to the massage table.  Again, I got a good referral for the Northeast Los Angeles area (my massage therapist extraordinaire also teaches yoga).

Energy Healing.  Okay, I can't explain this one very well but my practitioner clears away negative energy and charges me up with healing energy.  I have referred nearly a dozen friends to her and most all come back to me with stories about healing and transformation. When I interviewed her for a paper on healers for a UCLA class on Latin American Medicine, Shamanism & Folk Illness, she said most people come to her saying they are stressed and need something. She trained at the Lion Heart Institute and charges $70 an hour.  Email me if you are interested in this referral in the Northeast Los Angeles area.

Hypnotherapy.  I have yet to try this professionally myself.  When I was in grad school for the MSW, one of my preceptors was in an LCSW exam prep group and all but one of the members tried hypnotherapy before the oral exam.  All but one passed the exam on the first try.  Anxiety can make our thinking brain shut down so any treatment that calms and relaxes our mind-body helps us to perform better.  I hear this type of treatment is especially good for weight loss efforts, I have to track down the reference for that one. I downloaded some podcasts from HypnosisDownloads.org on weight loss, positive affirmations and how to stop insomnia.  I listened to the positive affirmations at bedtime with my daughter.  It is a very sweet recording and reminds me of the things a loving parent would say.  According to the website, we don't hear the good stuff enough.  One of my mentors swears by this type of treatment for his PTSD and anxiety.  I have a referral in the Pasadena area if you are interested...

Talk Therapy.  There is room for all healers in the 21st century.  I have met helpful therapists for individual, group, family and couples counseling.

Shamanic Treatment.  I had focused on mind-body-spirit healing for most of my life and neglected soul healing.  I didn't realize spirit and soul were distinct.  Shamans do soul retrieval and spirit helper work.  In traumatic situations, pieces of our soul can check out and not return until it is safe.  A shaman can journey to retrieve parts of our soul that have checked out.  We don't have to walk around with a maimed soul.  Spirit helpers are like guardian angels and may show up in the form of animals consenting to help and protect us.  Shamanic practices are part of almost every culture in the world, originally from Siberia, you will find shamanism in Korea, China, Australia, Africa, Latin America, Medieval Europe, Alaska, Native America, etc.  My ancestors are from Latin America and I had been completely cut off from our traditional spiritual healing practices, until now.  I met a gifted and experienced shaman in the greater Los Angeles area who charges $75 per hour or a flat rate of $100 per treatment and anything in between as you are able, please email me if you are interested...

Be well.

Writing is Healing

Pennebaker (1997) wrote about writing as therapy.  Here are some gems from the article:

"For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow."

"The mere act of disclosure is a powerful therapeutic agent that may account for a substantial percentage of the variance in the healing process."

In ancient indigenous cultures in Mexico, there was a community leader called "Comedor de Pecados" or "Eater of Sins."  It seems we have always needed a place to put it - a ritual for disclosure.


In this article, Pennebaker shares the standard script or writing directive used in his studies:

"For the next 3 days, I would like for you to write about your very deepest thoughts and feelings about an extremely important emotional issue that has affected you and your life.  In your writing, I'd like you to really let go and explore your very deepest emotions and thoughts.

You might tie your topic to...
...your relationships with others including parents, lovers, friends, or relatives
...to your past, your present or your future
...or to who you have been, who you would like to be or who you are now.

You may write about the same general issues or experiences on all days of writing or on different topics each day.  All of your writing will be completely confidential.  Don't worry about spelling, sentence structure, or grammar.  The only rule is that once you begin writing, continue to do so until your time is up."

"Even though a large number of participants report crying or being deeply upset by the experience, the overwhelming majority report that the writing experience was valuable and meaningful in their lives."

Writing has been found to be associated with...

• significant drops in doctor visits from before to after writing
• beneficial influences on immune function
• long-term improvements in mood and indicators of well-being compared with writing about control topics
• significant reductions in distress
• improvements in grades among students who write about emotional topics
• getting new jobs more quickly and reduced self-reported alcohol intake among Senior professionals who have been laid off from their jobs 
• lower rates of absences among university staff members who write about emotional topics compared to control participants

"When individuals write or talk about personally upsetting experiences in the laboratory, consistent and significant health improvements are found.  The effects are found in both subjective and objective markers of health and well-being.  The disclosure phenomenon appears to generalize across settings, most individual differences, and many Western cultures, and is independent of social feedback."

Reference:
Pennebaker, J.W. (1997).  Writing About Emotional Experiences as a Therapeutic Process.  Psychological Science, 8(3), 162-166.

Self-Care or In it for the Long Haul

Summer always gives me time to pause and reflect on self-care, otherwise known as how to stay in it for the long haul - tenemos que durar.

One of my first assignments as a school social worker was at an elementary school in South L.A. In the first couple of months I hospitalized a student for suicidal ideation and behaviors (I was on campus until 9pm on a Valentine's Day Friday!) and advocated for services for a 5th grader with conduct disorder. The challenges and drain of day-to-day work drove me to a chiropractor where I met one of the most gifted healers in the form of a massage therapist. When she asked, "What brings you in?" I said, "It feels like I am wearing a leather outfit that is two sizes too small." She prescribed weekly massages to get me back into shape. I went dutifully every Friday after work and it was the most wonderful way to end the week and begin the weekend ($40 a week very well spent, in my opinion). I heard someone say that for real results, you need to do all three - chiropractor, massage and accupuncture - and I tend to agree. I would add that supplements are helpful, too - Omega-3s and all the B vitamins - they have done wonders for my mood and energy-level. Dr. Carl Bell*, an African-American psychiatrist who writes about how protective factors can promote resiliency and mediate the effects of trauma, advocates looking at the nutrition of children exposed to trauma, particularly those in foster and group home care. He recommends Omega-3s for brain development and mood regulation. Improved mood regulation equals improved foster placement stability.

*(These lecture notes courtesy of my friend, Jon Pettigrew, MSW)

This makes total sense because, we are not at our best when stressed. And yet, isn't this when it matters most, that is, how we choose to behave in our darkest hours? It follows that we need more good stuff in those moments for balance - good stuff like good nutrition, exercise, resources, protective factors, support, in order to equalize the demands and capacity equation.

In the Winter Quarter of 1998, I also enrolled in an art class taught by the L.A. Latino artist, Roberto Gutierrez, at Plaza de la Raza. It was, and still is, the best $50 I ever spent on nine weeks of art instruction and nurturing support. After work, every Monday, I showed up and worked on a charcoal drawing of my self-portrait. I have taken other classes from Roberto - watercolors, acrylics, assemblage, contour drawing, ink drawing, crayon resist, etc. My daughter attends with me now too. Roberto calls her a serious artist. Roberto is now my mentor and dear friend. His conversations and discussions in class were always so funny, positive, motivating and nurturing of his students, so I asked him one day, "How do you manage to be so positive and nurturing?" He told me about how he used public transportation and listened to positive visualization tapes during the trips. It was clear he was feeding himself good stuff because he was sharing good stuff with us. Good stuff in - good stuff out.

Self-care also includes taking care of ourselves financially. I have been saving for retirement, on and off, since I was 21 years old. In this line of work, or any for that matter, I suspect that after turning 55, it will be nice to have options rather than feel forced to continue working due to financial pressures. I think about what our bodies will have absorbed and stored by then - layered over the years in our line of work.

I guess my assertion is that every helping professional deserves a body healer, a creative outlet that puts you in a state of flow and retirement savings. Good nutrition and exercise are the foundation. Any tips, referrals and stories about what works for you?

Summer Actions and Reflections

Summer can mean so much. After a whirlwind year - an intense rollercoaster ride - it means slowing down, taking breaks whenever I can make them happen, rejuvenating, starting projects that seem impossible when the year is in full swing (for instance, an attachment-themed book club), and taking care of all the business that got left behind.

To that end, I...
...am spending more time with my girl and my man
...met with a financial planner
...enrolled in a couples communication class
...went to the dentist
...log meals and exercise on an iPhone app
...take a tennis class
...signed up for a nutrition and cleansing program
...took my daughter for a physical
...walk 3 miles at a time almost everyday (!) for social and recreational purposes
...finally got rid of the grey, which made me consider letting the grey grow out (hmmm)
...am having lots of dates and fun with friends and family

It is amazing all that it takes to make my life stay in balance with the introduction of a major stressor/incredible opportunity (the ying and yang of going back to school). I am grateful for all the personal and social resilience factors in my life - trying to get my bounce back this summer. ;)

How are we worse for the wear? What can be done about it?

"Constructivist self-development theory is interactive in that it view's the therapist's unique responses to client material as shaped by both characteristics of the situation and the therapist's unique psychological needs and cognitive schemas."

"The effects on therapists are pervasive, that is, potentially affecting all realms of the therapist's life; cumulative, in that each client's story can reinforce the therapists gradually changing schemas; and likely permanent, even if worked through completely."

In 1966, Carl Jung "originally conceived that an 'unconscious infection' may result from working with the mentally ill."

In 1976, English described this process: "As the emotional needs and distresses of people in difficulty were presented to me, I not only felt them through the process of empathy, but I also found I tended to absorb them within myself as well."

In 1978, Chessick hypothesized that "conditions of depression and despair in one's clients (which he calls 'soul sadness') can be contagious."

In 1985, Farber cited "evidence that the client can transfer his or her pathology to the therapist."

In 1987, Guy cited "research which supports the notion that doing psychotherapy can be dangerous to the psyche of the therapist."

In 1990, McCann presents her "notion of vicarious traumatization...implies that much of the therapist's cognitive world will be altered by hearing traumatic client material."


In 1999, Figley described secondary traumatic stress and compassion fatigue as "a reaction from indirect exposure to a traumatic event...as a result of the therapist's own empathy towards a traumatized client in addition to the therapist's own secondary experience fo the traumatic material."


In 2007, Hernandez formulates "a new concept: vicarious resilience. It addresses the question of how psychotherapists who work with survivors of political violence or kidnapping are affected by their clients' stories of resilience. It focuses on the psychotherapists' interpretations of their clients' stories and how they make sense of the impact that these stories have had on their lives."

In 2007, Radey and Figley, coin the construct "compassion satisfaction" in the "broader context of positive social work...a paradigm shift towards identifying the factors that lead clinical social workers toward human flourishing in their field...compassions satisfaction or feelings of fulfillment with clients, rooted in positive psychology and expanded to incorporate the social work perspective. The model suggests that affect, work resources, and self-care influence clinicians' positivity-negativity ratio, which in turn can result in compassion satisfaction. To maximize compassion satisfaction, research, education, and training should consider how classroom instruction and workplace policies can promote the most success among clinical social workers."

There is energy exchange between client and therapist. What do we know about this exchange and how can we manage it in the best interest of both parties?

I frequently get massages for health maintenance and self-care. I forego other treats in favor of this one. I have had massages by practitioners up and down the State of California. On a few occassions, I walked in congested and by the end of the hour, walked out breathing easy. On both occassions, I heard my masseuse walking out with those sniffles. I wondered if there had been an exchange of energy and wondered how it had been transfered. After this experience, I asked two different practitioners about what they were taught and how they deal with their clients' release of toxins and energy. They both said that they set their intention at the outset of the massage to release the energy that no longer serves the client, but not take it on.

What are mental health professionals taught about this? We are taught about setting limits and boundaries. Understanding where we begin and end. Empathizing but not becoming responsible for our clients problems. But it appears that empathizing is both a vehicle for the clients' healing and a potential risk hazard for the therapist.

I remember working in South Los Angeles as a beginning social worker and feeling overwhelmed by the sense of hopelessness and despair that is "in the air." I remember thinking that it tapped into my own experience growing up in East Los Angeles and the air of hopelessness that can linger there. I remember wondering if this pre-existing vulnerability made it difficult for me to work in this environment and with this population. That is when the concept of resiliency saved my life. It reminded me of the other side of the story. The truth that despite the risks, most of my classmates were indeed living, loving and working well in adulthood. There is hope, despite the risks.

Early on in my career as a school social worker, I used to get weekly massages for $40. That gifted healer taught me that rather than release the energy accumulated at work throughout the week (my massages were on Friday evening), I could notice the energy coming towards me and shunt or redirect it away from me and not allow it to enter and be processed by my own body. She was like that. She spoke metaphysically and I usually only half-understood. But over time, I practiced this somehow. The visual metaphor helped to give meaning or grounding to the experience - like a guided visualization.

Because of neuroscience research, we now know about mirror neurons and how two people can sync up, right-brainwise, that is. Reevah called this, in the tradition of psychodynamic psychotherapy, knowing a lot about a person by how they make you feel when you are with them for five minutes. In Eastern medicine, this might be called energy or chi/qi. If this is happening between us, it would seem beneficial to explore this further, for all our sakes.

I am fascinated by what we can learn about this transfer of energy, how to manage it and what purpose it serves.

References:
Radey & Figley. (2007). The Social Psychology of Compassion,
Hernandez, Gangsei, & Engstrom. (2007). Vicarious Resilience: A New Concept in Work With Those Who Survive Trauma
McCann & Pearlman. (1990). Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims.

Self-Care is good for Self and Others

Abstract from Compassion fatigue: Psychotherapists' chronic lack of self care by Charles R. Figley:

Psychotherapists who work with chronic illness tend to disregard their own self-care needs when focusing on the needs of clients. The article discusses the concept of compassion fatigue, a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference. It includes a multi-factor model of compassion fatigue that emphasizes the costs of caring, empathy, and emotional investment in helping the suffering. The model suggests to psychotherapists that limiting compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. The model also suggests that, to limit compassion stress, psychotherapists with chronic illness need to develop methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. A case study illustrates how to help someone with compassion fatigue.

Why Self-Care?

The rate of depression is about 15% in the general population.

Among Social Workers, it is about 30% - double the rate of the average person.

What are our ideas about the 30% among us - stigma or acceptance?

And why is the rate of depression so much higher among trained professionals who probably know more about the symptoms, treatment and resources available for depression than the general population?
Is it harder to recognize when it happens to us?
Is it hard to acknowledge in ourselves when we compare our general good fortune to the often difficult circumstances of our clients?

There is more research about secondary traumatic stress (STS) now. What individual and organizational changes can we put into place to prevent and treat the impact of STS - for everyone's sake?