Emotional Recovery

Emotional Recovery

When you think of physical recovery after an intense workout or running a race – what comes to mind? Possibly:

  • Hydration
  • Mobility/Stretching
  • Rest
  • Sleep
  • Nutrition

Intense physical exercise, focused on the same muscle groups, day after day, is counterproductive, as it doesn’t allow for the repair cycle, and instead causes repetitive small injuries. While the small injury that occurs after one intense workout is beneficial with rest, as the muscle is allowed to repair itself and becomes stronger.

When you think of emotional recovery after an intense session or a multiple hour session due to a safety planning intervention for suicide – what comes to mind and are we as diligent at applying these recovery methods?

The research studies I’ve reviewed about emotional burnout are still unclear about exact causes and conditions, yet they have been able to define the symptoms burning as exhaustion, alienation from activities, and reduced performance.

Prioritizing our emotional recovery with the same awareness we allow ourselves to recover from physical exertion, I believe, could support healers in growing and becoming stronger from the intensity we experience in supporting others.

What steps can you take to support yourself in emotional recovery?

Hero’s Journey

Joseph Campbell, renown for unifying concepts from literature across many different cultures, developed the philosophy of The Hero’s Journey. The Hero’s Journey seems to identifiable and meet warmly in many different contexts. When I see clients, especially those re-entering their life after a residential stay for substance abuse, able to structure their story similarly to the Hero’s Journey, they seem to be welcomed back and offered support.

What are ways you identify with the Hero’s Journey?

What are ways you can support your clients in identifying with the Hero’s Journey?

Confidentiality vs Secret Keeping in Group Therapy

Without guidance it’s easy for members of group therapy to do old patterns of secret keeping when trying to maintain confidentiality. Clients, especially those with parents that experienced trauma and/or addiction, may have been instructed as a child to not speak about what goes on at home. Without a clear explanation of what is okay to speak about in regards to group therapy, it’s easy to repeat historic patterns. When asked about a group, and a client says “I’m not allowed to talk about it”, that’s actually not true. So what can clients speak about while maintaining confidentiality of other group members?

General Topic

It’s important for clients to be able to speak about the topics covered in group therapy. Speaking about general topics, such as childhood trauma and the long term impacts, can support the client in educating their support network about what they are working on and ways others can offer them support.

Their Experiences

Clients may speak about their personal experience in group therapy. It’s important for clients to be able to speak about their insights, challenges, hopes, and practices to others in their life.

The Therapist

While the therapist must maintain confidentiality of all group members, and group members must maintain confidentiality of all other group members. Anything the therapist says or does may be talked about to others. Clients are encouraged to bring up concerns or disagreements to the therapist and practice direct communication. The clients may relate lessons or stories shared by the therapist to others. 

Finally, it’s also important to speak to and have a written agreement about the consequence of not maintaining confidentiality.

Who goes first?

There’s many ways to choose which person to lead with in a group session, and I will cover some other options on how to choose llater on. The choice I repeatedly make is by choosing a group member who has been vulnerable in check-ins and warm ups. This member can role model to others in the group and in turn support the releasing of overly protective parts in other group members so deeper work may be done.

Beginning the Practice of Emotional Fitness

What comes to mind when you think of ways to maintain or improve your physical fitness?

For me, I think of high intensity interval training, strength training, mobility & stretching, setting new goals for myself in gymnastics training, sleep, hydration, and nutrition. 

Now think of ways to maintain or improve your emotional fitness and how frequently you engage in them. 

I was oblivious for years, and then for years ignored, ways to improve my emotional fitness. Now, I engage in several techniques on a daily basis. The techniques shift over time, just like my interests in different physical fitness techniques change over time, yet I still engage in regular practices. Our emotional wellbeing can be shaped similarly to our physical fitness with different exercises and practices.

What’s an emotional fitness technique that you are willing to begin practicing daily?

Questioning Ourselves

What did you believe in five years ago that you no longer believe in today?

This is a question Peter Attia, MD, frequently asks his podcast interviewees. 

I believe this question is vital to ask ourselves on a regular basis. 

The scientific method never proves a belief, we can only see it as not yet wrong. As our understanding of the world grows, both individually and within the research communities, it’s valuable to recognize the changes and incorporate them into our world views. 

Some things I believed five years ago that have changed include…

  • Previously I believed: SSRIs are unlikely to have negative effects and may be helpful. 
    • Now I believe: SSRI’s are likely to have negative effects for most people. While they may still be beneficial for some people, it’s important to support clients in treatment methods with minimal risk first. 
  • Previously: CBT is highly effective and can be used in many circumstances. 
    • Now: CBT may have been subjected to an amplification of benefit and overgeneralization in usefulness. It’s still useful in some areas, yet not as many as I used to believe in.
  • Previously: Clients in emotional distress need psychological counseling interventions, and if not improving a referral to a psychiatrist. 
    • Now: Clients in emotional distress may be due to cause that’s not physiological. Wellbeing may be found though a combination of interventions including psychological, nutritional, medical, lifestyle, spiritual, physical, social, or another area.

What are things you believed in five years ago that you now have new beliefs around?

Explicit vs. Veiled Self-Care

When you’re practicing self-care in session, you may wonder if it’s beneficial to be explicit about the practice or discreet, and I would say the answer is – it depends. When I’m experiencing emotional challenges from a client interaction, it’s likely there are other group members who could benefit from regulation practices, so I will guide the group in regulating while allowing my nervous system to reset. There’s been a few times when the stimuli has come from an outside source, such as an earthquake or the example below, where I will explicit speak to what’s happened for me, eg I noticed my stomach tighten as the building shook, and guide clients’ to check in what’s happened for them.

There was one time when I was in session only a month after I had graduated. I was doing my best to be completely present in session and provide significant value to the client. Though for about 10 minutes I had been noticing this light touch on my calf; I assumed it was the draw string of my capris in the breeze. The sensation doesn’t stop and it’s been about ten minutes, I finally look down at my calf and can just glimpse a part of a very large cane spider crawling up my leg and underneath my capris. At this point in my life I still had a very active fear of spiders, and I don’t remember the next few seconds.

What I do remember is dancing around on top of the coach shaking the spider from out of my capri. This is quite an odd position to be in, especially as the therapist, during a session. What I was able to conjure up from standing on the couch, is explicitly walking through some regulation processes and describe what was happening and what to do about it. This went something along these lines:

  • I’m in the flight stage now. I’m going to shake my limbs to support in discharging the adrenaline.
  • Now that I’m slightly calmer, I’m going to step off the couch and will focus on taking deep breaths.
  • Lastly I’m going to stretch and check in with my body.

This experience turned out to be a significant gift to the client. In each case when you’re looking at guiding grounding exercise in groups and wondering about being explicit about your state, consider what’s best for all of the client/s.

Self Care of the Therapist in Session

I’m guessing most of you are familiar with self care for therapists, yet have you thought about self care during sessions and what that could look like. If you’re sitting in a room with a client who is hunched, the neurons that fire in your brain when you hunch over are likely activated, even if you’re sitting up right. This is due to mirror neurons; neuroscientist Vittorio Gallese, MD, PhD, describes “this neural mechanism (as) involuntary and automatic.” When you are feeling a little stressed, nervous, depressed, or emotionally off kilter, it’s likely the client is feeling similar or worse. When this happens in session, I suggest guiding the client/s through regulation exercises. These could be some of the ones listed in Grounding exercises, or something completely different.

It can be helpful to have several exercises that you know will benefit the group that also allow you to step out of the room for a minute so you can take a breather, get a drink of water, or take a shake. An exercise I commonly use for this purpose is a listening exercise. I prompt the group to list the traits of their ideal listener. The group usually comes up with characteristics like accepting, patient, loving, kind, fully present, etc. Before creating the list, I ask the group if they would prefer the list to be what it is, not what it’s not. Usually the group wants this, so if non-judgmental is suggested, you can respond with a yes, and ask the group a way to describe what that would mean to them, so usually accepting or open minded may be used instead. Pair up all participants, and instruct them to select who wants to be the first listener. The other person will then speak for 4 minutes about something they want to explore in their life. The listener only listens and doesn’t speak, yet practices embodying the characteristics of the ideal listener. You can then step out of the room for a couple minutes, say if you need to change your shirt as someone spilled coffee on it as they were coming to group or if you just need a two minute breather to reset. You showed up as the professional, even though you may not have felt like starting group with coffee on your shirt. You role modeled what it’s like to maintain a commitment even when it was challenging for you, and you are still able to care for yourself and change your shirt out during the break you created for yourself.

Especially in the substance abuse treatment center I work with, it’s important for the clinical team to model showing up. Clients could be struggling with much more difficult challenges than the treatment team, such as detoxing and not feeling so great. Clients monitored our behavior closely to see if we were walking our talk.

At the end of the four minutes, guide a discussion for the both the listeners and speakers about what was challenging about the exercise, what beliefs came up, and what was easy about the exercise. Common things that come up are:

  • Difficulty in listening and not offering suggestions
    • Ask how else this applies to their lives, eg do they have the ability to sit with the discomfort of their own experiences or are they constantly trying to fix something so they don’t have to feel discomfort? What is it like to bear witness to the pain of another? What would it be like to be present to their own discomfort?
  • Beliefs around boring the other (underlying of not being good enough) – How else does this apply to their lives? In what ways do they dismiss their concerns and focus on another?
  • “It was easy, no challenge whatsoever on both listening and speaking”
    • Evaluate for dissociation, people pleasing, ability to connect with others, or maybe this was easy for them. The questions for follow up would be tailored to what you believe may be happening.

You’ll begin to see different patterns based on your theoretical lens and develop questions that will support the clients in recognizing patterns, seeing how these patterns affect their lives, and ways to operate differently. There’s frequently the desire to want to be able to offer this type of present listening more often to others and also to themselves. I would frequently pair this exercise with a assignment to do outside of listening to practice this style of listening of others and themselves a couple times a day for the next week.

Speech & Debate – Empathy for the Unknown

Speech and Debate, a play performed by students at Western Oregon University, showed me a glimpse of the emotional experience of a teenage male coming out in high school. In the production, the school’s Gay Straight Alliance only had three members. The students that are gay demonstrated their difficulties in finding self acceptance, the challenges in finding partners, and desire for connection

When I was in high school, I was completely oblivious to the challenges faced by a friend. I wanted to impose on them the values and fears I was raised with. I didn’t stop to think about the vast differences in challenges we faced. I’m guessing back then I offered a whole lot of advise. While I’m much better at seeking to understand first, I still find it beneficial to expose myself to different experiences. I’m thankful for the students for portraying these life experiences.   

Who is a person in your like that you can seek to understand more?

Parts of a Group Therapy Session, Part 2 – The Warm Up

After your clients have mentally arrived through the grounding exercises, it’s time to begin the warm-up. The warm up is a time for clients to start thinking about what’s most important for them to work on, while fostering internal and external connections. It can be a time to awaken both sides of the brain through metaphorical thinking. I was taught by an amazing facilitator at Onsite, that there’s no such thing as resistance, only not enough warm-up. The following are some possible warm-up exercises, with an emphasis on metaphors:

The Keys

Ask the clients, “Think about the most meaningful thing you could unlock for yourself today. What is it that you want to unlock? What key unlocks this for you and why?” Inspired from workshop on Onsite.

Stature or Movement

Guide participants to think about what they want to achieve or work on today, and how that would translate into a feeling in their body, and how this feeling would lead into either their stature or in their movement. Each participant will have a turn expressing what they would like to work on today, and how working on that would be evident in their body through their stature or movement.

Yeses and Nos

Have all group members pair up, while one person only says yes, one person only says no for 30 seconds to a minute, then have participants switch roles. Ask each member what they were saying “Yes” to. Then ask each member what they were saying “No” to. Lastly, ask if anything else came up for them around their reactions to the exercise. Group member with specific explanation of who or what they were saying Yes or No to are warmed up and ready to do work. Inspired from workshop on Onsite.  

The participants answers will guide the experiential work done in session. With practice, as you listen to their responses, you will be be able to pair meaningful exercises with each response. These are just a few of the hundreds of possibilities. You will be able to determine what warm-up best suites the group’s needs. The group could be very low energy, so a movement grounding and warm-up can support them in energizing while connecting with their bodies.