I recently watched the video “How Life Looks Through My Whale Eyes.”  It is a very short documentary made by James Robinson, a young man from Maine, to show his family what it is like to live with several disabling eye conditions that have not responded to treatments.  With humor and authenticity he reveals the sense of humiliation he has endured throughout his life in not being understood.  Bravely his family is put through a series of optical tests and is candid about their lack of awareness regarding his experience.

https://www.nytimes.com/2021/07/14/opinion/strabismus-vision-disability-relationships.html

What touches me the most is how his parents and brother, who obviously love him very much, are so open about how ignorant they are.  We can only imagine how these parents navigated a private journey of how to best support their beautiful son who they wanted to have all of life’s opportunities despite his disability.  But in doing so, James ends up feeling isolated and unseen.  In follow up to my last post, regarding needing to be more aware of what we don’t know, this really hit home for me in a deep manner regarding our ignorances.  Sometimes what we don’t know is because we are too afraid to ask.  This directly relates to our capacity to be vulnerable with the very people we want and need to be closest to.

One of the things that you learn as a therapist is how hard it is for people to share their most sensitive selves with the people most important to them.  Our work in therapy is often to peel back layers of shame and fear that serve as barriers between people. These walls most often create a deep sense of loneliness and disconnection as well as serve as a breeding ground for misunderstandings.  For example, just this past week, a woman who I work with who had gained weight during the pandemic shared about her self hatred in how she “disgusted” her husband.  Her conclusion was based on the fact that he hadn’t been as affectionate with her.  She battled herself and chided herself, and underneath became resentful of him which led to her withdrawal.  In sessions, we worked on her approaching her husband with her concern and desire to be close to him.  For her, the fear of rejection and the possibility of having her beliefs validated, was excruciating.  But when she finally did get up the courage, she learned he had his own demons lurking, feeling stressed about his cut in work hours during the pandemic and feeling like a poor partner who wasn’t “pulling his weight.”  The two were literally able to laugh at their own versions of self-inflicted “weight issues” and she reported feeling closer to him than she had in a long time.

I know, despite my awareness of these barriers with the people I work with, that I am guilty of it as well.  I will sometimes avoid asking questions to people in my own family because I am uncomfortable asking.  I worry that I’ll offend them or embarrass them and the last thing I want to do is cause them more pain.  But if I’m honest with myself, and this video brought this home to me, maybe it’s less about them and perhaps more about me that I am protecting.  I’m afraid of being uncomfortable and worst of all, the possibility that I will say the wrong thing which will make me feel like an insensitive fool, and worst of all, a bad mother.

“How Life Looks Through My Whale Eyes” teaches me that, most often, not asking is more hurtful than an awkward ask.  With silence and ignorance we send a message of disinterest, judgement, and fear.  We perpetuate misunderstanding and exclusion.  As Mr. Robinson says regarding his experience with others regarding his disability, “I don’t have a problem with the way that I see.  My only problem is the way that I’m seen.”

My daughter sent me an article about something she was learning in one of her classes in college.  During the Carboniferous period, 300 million years ago, giant insects roamed the Earth. There were predatory dragonflies with two-foot long wingspans and scorpions the size of skateboards!  Besides “eeeewwww,” we both had the same reaction.  Giant insects roamed the Earth?  How the heck did we not know this before?  This got me thinking about how very, very much we don’t know.  

In graduate school, one of my professor’s would repeatedly remind us:  “When thinking about your clients, you always don’t know more than you know.”  In other words, we see our clients for an hour a week out of 168 hours.  They tell us about only a fraction of what their experience is and this is filtered through what they want us to know and what they themselves allow themselves to know.  With so much unknown, it is natural to fill in the rest with our own perceptions and ideas.  To be a good and helpful clinician, you have to be careful about the assumptions you make and the biases you bring.

This is true of every interaction we have.  In fact, when you talk to a neuroscientist, such as Michael Taft, he will explain to you that “no human being has ever experienced the actual world.  Your experience of the world comes to you through the signals of a group of peripheral devices, called “senses.”  Your brain takes all of the information gathered through your senses and interprets them into experiences.  The more experiences you have, the more data your brain has to interpret any new experience.  In other words, the older we are, the more we may think we know.  

The assumptions we make in thinking we know about others is based on the projections of our own hopes, fears, and worries.  Often they cause us to interpret what other people say in ways they may, in fact, not have intended. And often, the more history you have with someone, the more you think you know who they are and what they would think or feel.   When in reality, this may only be the result of a deeply entrenched dynamic based on a history of layer upon layer of perceptions that seem to confirm themselves.

So given that we can’t possibly know everything there is to know, or even know what we don’t know, we have to be careful with our interpretations.  In order to do so we have to be open to both what we may be assuming and what we may be missing in our relationships.  It’s good to stay curious and ask questions.  While it may feel comfortable to think we know how our loved ones feel or what their opinion might be, be open to change.  We all do it, and it could be exciting to learn something new about someone or understand how they have grown.  You might just be surprised at what you find.  Hopefully, nothing as creepy as a  four foot long millipede!

Like a lot of father’s, my Dad worked very hard to take care of his business, our home, and even our lawn. Unfortunately, he wasn’t nearly as diligent when it came to his own health.  He was frequently quite stressed, had little time for exercise, and rarely saw the doctor until he had to.  Now that I’m married to a father, I’m seeing the same pattern, often helplessly worrying and wondering about him.  From my experience in working six years at a Health Center, I can say in general the average male has a hard time with regular and preventive health care.    So this Father’s Day it might be good to think about the health of the men in our lives and support them in promoting their own health as a priority.

Research shows that men are 80% less likely to use a regular source of healthcare, such as a primary care physician, then women.  By age 45, heart disease and cancer are the leading causes of death for all groups of men.  For men in their 20’s and 30’s, access racial and ethnic groups, unintentional injuries and suicide are the leading causes of death (not true for women).  Men tend to get less sleep, partake  in heavy drinking, and engage in fewer hobbies and exercise than women.  Men also have shorter life spans than women, especially men who are not married.  The good news is that changes in behaviors can have a huge impact in all of these areas.  

Research tends to show that men do not make deliberate choices to engage in less healthy behavior, but they do so because their lives and environments make unhealthy choices easier than healthy ones.  According to Will Courtenay, a researcher on men’s health,  “Men, we found, tend to view their bodies as tools to do a job.  Health is not something they pay attention to until it gets in the way of of their ability to go to work, have sex, or do something else important to them.”  In fact, men are more likely than women to adopt behaviors and beliefs, including beliefs about manhood, that increase their health risks.  In the same way that men  won’t stop and ask for directions, they also tend to want to find their own way with their health.  Because of this, they don’t get the right health information and early screenings that may help prevent disease.

For men, being perceived as weak is a big trigger of shame.  They’re afraid to make themselves vulnerable for fear of being perceived as weak, especially when it comes to their body self image and pain tolerance.   Men tend to avoid talking about health problems and don’t seek help when problems arise as a way of maintaining control. Self-sufficiency is a cultural value for many men in our society, which leads to less social support and decreased opportunities for education and promotion of healthy behaviors.  For a lot of men, health care is something done to them, not something they participate in. 

Research consistently shows that women are important health factors in the lives of men.  Wives, daughters, and other women are important sources of information about health and often play a key role in helping men understand and cope with stress.  Research also shows that it is often a woman who schedules the  appointment for men when they do seek medical care or at least were the one to insist that he go.  

But from what I can tell, women often have had the benefits of regular check ups because they’ve been the ones to shoulder the responsibility of birth control and child bearing.  The role of how and when to be a mother plays a big part in their better participation and health awareness.  So perhaps this Father’s Day we can offer the same benefits to men in their roles and responsibilities of being fathers (or not becoming fathers).  We can encourage and support men in being healthy and insist that taking care of themselves be at least as high a priority as fertilizing the lawn or maintaining the BBQ.  While we so appreciate all that they do to take care of house and home, we much prefer they do what they need to do to be here with us as long as possible!  Perhaps our best gift to them today is to help them find time for their own mental and physical health.

I was thinking about all the young people graduating this Spring, coming from a strange year of Covid isolation and home schooling out into the big wide world.  And then I was talking to both of my daughters, one recently graduated and the other still in college.  Each was strongly affected by the isolation of the pandemic, relying gratefully on a few engaged professors or workplace mentors to make their way in unfamiliar, yet intensely complex landscapes.  It got me thinking about the power of connection and the need for mentors, not just any mentor, but reliable, trustworthy and compassionate ones.  Especially in a year of declining mental health in our young people and soaring rates of anxiety, the power of just one person with experience and integrity can be monumental.

When our kids are young, we worry about who their friends are, if their teachers and coaches will be good role models and support our values, and, hopefully, try to be good role models ourselves.  But as they get older, they naturally move in larger circles and have new authority figures and people who influence their lives in important ways that we know nothing about.  It takes a great leap of faith to trust that these influencers will have our young people’s best interests in mind and if they will offer the kind of support that will help them grow.  Research strongly demonstrates the benefits of having good mentorship in lowering rates of absenteeism and isolation and increasing self confidence and career engagements and promotions.  And research also supports the benefits of a mentoring relationship on mentors, who showed greater job satisfaction and reduced anxiety as a result of providing mentorship.  Clearly mentoring has a positive influence on both parties.  But what about when it is not?  Research also shows the detrimental effects when we feel taken advantage of or mistreated by a person with great influence.  It can have a long lasting effect to shut down young minds and curtail developing ambitions.  

And you don’t have to be young to have the need for good mentorship!  Just this week my boss expressed a compliment for something I didn’t think he had noticed about my work. I was surprised at how much it meant to me and the impact it had on my sense of self at work. Especially in this difficult year, working in the isolation of one room in my own home without the benefit of others to bounce ideas off of or from whom to get a reality check with, it’s at times completely crazy making.  In this atmosphere of isolation, we’re left alone with our own fears and insecurities growing unchallenged inside our minds.  The intimacy of mentorship breaks this self fulfilling loop and allows us to practice expressing our thoughts and test our ideas in the light of day before we act on them.  We get feedback and support as well as a person invested in our success.  How often did we all assume that the people on our screens were better informed or were judging us in some way?  How hard was it to read the intentions or feedback from an audience of two dimensional images who frequently froze up or couldn’t hear or see us?  Zoom fatigue is a common phenomenon, even for those with years of experience and confidence in their social skills.  It’s been a minefield for young people trying to find their voice and their place among their peers.

I will be forever grateful for the people who have and will guide and support my children, no matter their ages.  And for the people who guide and support me, no matter my age!  It’s truly a pay it forward process of giving and receiving throughout our lives.  Nobody makes it on their own, we all have help and people who came before us as our guides. And we all have a sphere of influence, no matter our age or our roles in life, with which we can offer others support and connection.  I can’t imagine a better time to reach out to someone as we come out from behind our screens and step into life once again.

This past weekend my mother in law turned 80. The timing was perfect for most family members to be vaccinated so we could gather together to celebrate. While strugglng with some back issues that have slowed her down of late, she is a person who I feel confident will have many more years of joyful living ahead of her. She is truly one of the most optimistc people I know and will embrace each year as a blessing. Watching her raise her glass to toast her life got me thinking aout all the benefits, both psychologically and physically, that come with being such an optimist.

Research has consistently linked optimism and overall health and longevity.  Optimistic thinkers have lower rates of hypertension, heart disease, lower cancer risks, and lower rates of overall mortality.  One large study published in 2019 (research from Harvard and Boston University) determined that optimists have a life span 11% to 15% longer than average and are more likely to live to age 85 or older!  And this statistic holds true regardless of socioeconomic status, health conditions, depression, social integration, and healthy habits.  One reason believed to underlie this trend is that optimists, when faced with a situation, believe that they can change the outcome, therefore engaging in more proactive behavior in response to a negative experience or diagnosis.

Optimists also tend to have long lasting relationships as well.  According to studies at Stanford University, this holds true even if only one member of the relationship is an optimist.  Optimism leads to a greater sense of perceived support from a partner, which helps couples feel an investment in resolving conflicts.  Optimists also seemed to have the effect of making their partner’s more optimistic and helped their partners be healthier.  Even in work relationships, optimists have better job security and higher job satisfaction. And when faced with hardship or setbacks, optimists tend to bounce back faster and use it to recommit to a goal.

So when reading all of these benefits, if you’re feeling pessimistic about your optimism, here is some good news.  Optimism is a trait that can be learned and developed.  According to Kings College of London, only 25% of optimism is based on inherited factors.  According to research on positive psychology at the University of Pennsylvania (go Quakers), anyone can learn to become more optimistic.  Researchers from Penn as well as Johns Hopkins offer these tips to improve your outlook.  Smile more.  Smiling, even fake smiling, reduces heart rate and blood pressure during stressful situations and increases your sense of well being.  Reframe.  When you are in a difficult situation, see if you can find the silver lining.  For example when stuck in traffic, instead of focusing on what you can’t control, think of what the time can offer you, such as listening to some new music or calling a friend (using blue tooth of course).  Have a learning mindset.  Think of challenges and hardships as opportunities for learning and growth.  Gratitude.  Each day take notice of the good things you have in your life, no matter how small.   

It helps to think of optimism as less of a fixed personality and more of a mindset or thinking habit.  At first it may seem like work to shift from the negative to the positive, but with practice, you can indeed look at the full half of the glass instead of the empty half.  And in time, perhaps we can become more like my mother in law, Enid.  Not only will you notice the full half of the glass, but you will drink it up and refill it again and again.

I used to feel a bit of heartache when my mother would buy me a carrot cake each year for my birthday.  Because I had liked it as a kid, she continued to believe it was my favorite.  She never asked me if my preference had changed over the many years and I never felt it was right to correct her.  But now that she’s gone, I often find myself craving carrot cake on every occasion she’s no longer here with me to celebrate.  I miss having that person who not only remembered what I liked as a child, but who so stubbornly sought to preserve her role in taking care of me in that special motherly way.

A mother’s love is complicated.  From my own experience as a daughter and from what hours of working with many young people has taught me, most sons and daughters long to be seen and accepted by their mothers for who they are.  And what seems like such a simple thing to offer your child, whom you adore and would give your life for, however, ends up being so difficult, ripe with misunderstanding and disappointment, potentially leading to years of quiet sorrow.  In living through my own trials and failures in parenting, I have come to appreciate the truly impossible task of clearing out your own opinions, desires, and perspectives in order to be the all loving, all knowing, and all accepting mother figure we like to think we could be.

As mothers, to begin with, we were born and grew up in a completely different generation than our children.  The world was so different politically and socially than what our children experience, it’s impossible to know what it is like for them.  And some mother’s even come from a very different culture or country, with language and nuances of meaning being a further barrier to understanding.  On top of this we have our own ideas and beliefs about what being a good mother is.  Often this agenda is born from a desire to correct what we felt was missing in our own childhood.  While this desire is noble in its intention, it may miss the mark of what is currently needed.  Since it’s based on a distant past, it becomes a blindspot to what is presently real and tips the balance of our perceptions to what we want to see and feel about ourselves as mothers rather than what our children want and experience of us.  And in our own efforts to protect our sons and daughters from mistakes, we may deny them opportunities for their own growth and decision making in the process.

And then there’s the most challenging thing of all as a mother – our role is constantly changing. As our kids grow, we’re continuously saying goodbye to how things were, letting go of how we understood everything about them, little by little, day by day, absorbing the grief and trying to stay open to a new way of relating.  But it’s hard to let go of being that most important person to our child!  Perhaps we mom’s hold on to our view of our daughters and sons when they were young because it reminds us of a time we had the power to know what they liked, fix what was hurting them, and be assured of our special place in their heart.  They needed us and we liked being needed.

And so now I cherish the carrot cake.  I understand it as my mother’s way of holding on to who she was to me when I was younger.  It’s hard to share our children with the world, even if we know it’s for the best. I truly miss having that person who knew my entire history and from this unique bond, thought she would always know what I wanted because at one point when I was younger I did, indeed, very much like carrot cake.  And that memory mattered to her even more than the cake.  And now that I have the perspective, thank goodness, it also now matters to me more, as well.

I’ve been thinking a lot about the power of images this week.  The sight of George Floyd on the ground with a knee on his neck will forever haunt me, as it does a nation.  Nothing captured my heart regarding global warming like the image of a starving polar bear in an article posted on Earth Day.  While statistics and charts actually relay more information, they just can’t move us the way an image can.  As it is said, a picture is worth a thousand words.  But what is it that makes an image so effectively grab our hearts and our imagination?

We are very visual beings, in fact a large percentage of our brain is dedicated to visual processing.  Images draw our attention and we process images so quickly, we’re not even consciously aware of it most of the time.  When we see a picture we can recognize a familiar object within 100 milliseconds and we can recognize a face within 380 milliseconds.  Our brains are wired to react to images, as quick processing of visual information would have benefited our ancestors in gathering food and hunting or providing information about a threat or danger.  Images that evoke emotions are given high priority in our central nervous system as a way of avoiding danger or tending to loved ones, both critical for survival.

In studying our emotional responses to images, psychologists have discovered a phenomena that is particularly powerful in capturing our attention and our empathy.  It is called the “identifiable victim effect,” and refers to research showing that we humans respond most intensely to images of an individual victim.  It is explained that in order to feel the tragedy, we must identify with an individual person (or even animal) experiencing it.  In doing so, it becomes personal.  There is a saying that one death is a tragedy, one million deaths is a statistic.  According to psychologist Paul Slovic, “The mind is very much geared to respond to a single person in need – whether it’s ourselves or a single person in front of us.”  In one study, Slovic and his collaborators put volunteers in an MRI scanner and watched how they made decisions about donating money to orphans in need.  They found that subjects chose to donate much more when they saw a photograph of a particular child than if they were presented with names.  The researchers found the extra generosity was attributable to increased activity in the nucleus accumbens, a brain area associated with pleasure and reward.  They concluded that images have a special power to generate the identifiable victim effect by triggering arousal in the brain.

History shows many examples of this effect.  Certain photographs have made a difference in changing people’s attitudes and behaviors in historic ways.  An image of a nine year old Vietnamese girl running after being burned by a napalm attack is credited with changing public opinion that helped to end the Vietnam War.  Another example is the photo of a Syrian boy whose body had washed up on a beach that captured the world’s attention to focus on the Syrian refugee crisis.  The Obama Administration began to protect African lions under the American Endangered Species Act when images of the lion “Cecil” were posted after being killed by an American hunter. The commonality of these photographs and others like them are that they show an individual victim.  In some way, in viewing individuals, we are able to see them in their vulnerability and are moved.  We are more likely to experience emotions when we focus on a single tragedy than when we feel overwhelmed by a large mass of people.

As we view body camera images from police officers involved in shootings and cell phone images taken by bystanders, we can now be witnesses to what used to happen in private.  These images not only illicit emotional outcry but can serve to bring accountability if we use them for justice.  Images are a way of showing the world what happened and preserving the story in its rawness.  With that, images are powerful agents of change.  And with any tool of such great power, we need to use them carefully.  Images can mislead if not given the appropriate context or can exploit subjects by those who own the power of the image. So when our hearts are opened by an image, we need to also use our heads.  Images can provide emotional motivation, but it’s the thoughtful commitment to action in response to our emotional reaction that creates lasting substantial change.

As one of my client’s put it this week, “The good news is I got my vaccine and soon things will be back to normal.  But the bad news is I got my vaccine and soon things will go back to normal.”  What she talked about is exactly what I think a lot of people are feeling right now.  That after over a year of being isolated and in various forms of lock down, it’s kind of scary to go back to the hustle and bustle of life.  Even if there are things we couldn’t wait to do, longed to do, even dreamed of doing, it’s a bit awkward to come out of our cocoons again.  It’s a natural part of being human.  We adapted when things locked down, and now we must adapt to things opening up and re-enter the world of driving in traffic, eating at restaurants, going to gyms, and maybe even a movie theater.

I’ve been working at home for over a year now.  Since my co-workers are mostly all vaccinated, my boss asked me to come into the Health Center to give a training to front line staff members.  Although I’ve worked at my Center for over 6 years, I was nervous!  I couldn’t sleep the night before, I left the house super early so I wouldn’t be late, I worried I wouldn’t know where to park or where the office they wanted me to work from was, and worried about who I would know and how things had changed.  And as I pulled up and used my ID Badge (which took me time to find) it all felt so familiar and yet so strange.  

For many people, the slower more isolated life was actually more comfortable.  Especially people I know who have some anxiety or social phobia tendencies.  The longer they’ve been away from social interactions and venturing out of the house, the harder it feels to go back.  And things have changed, there are new rules and new protocols that make us nervous about going somewhere familiar that is now unfamiliar.  It’s been an extremely stressful year with a lot to be anxious about, so most of us have been anxious in some way for a long time.  We worked to cope by finding joys in small things, mostly more quiet and calm, that we found solace in.  It’s hard to think of suddenly letting go of our safety nets and rushing out to embrace the wide world again.  I have heard so many parents complain about their kids acting out and not wanting to go back to school.  Especially for children, the last year has been a big portion of their young lives!

In examining this re-entry phenomena (a term often used to describe soldiers coming back from war or explorers coming back from an expedition), Julia Samuel, author of This Too Shall Pass writes:  “Most of us have an uncomfortable relationship with change because familiarity gives us a false sense of security and control – its an evolutionary defense mechanism.”  It took a lot of effort to get ourselves used to a strange world of Zoom calls and social distancing, reading facial expressions behind masks and finding new things to do on Saturday nights.  It’s unreasonable to expect that we can just jump right back into the life of our old social selves again without discomfort.  For one thing, we aren’t the same people we were before the pandemic began.  According to one study by the UCL, only 9% of people surveyed planned to return to living exactly as we did before COVID hit.  Many have re-evaluated aspects of life and how we want to live it. There is no way that we can go through the experience of having life so suddenly shut down without forever being changed by this effect on our perceptions of predictability and vulnerability.

So be easy on yourself and take it slow.  It helps to acknowledge your anxiety as a first step to taking back some control.  Plan some small outings with people you tend to feel safe with or places you have enjoyed and felt comfortable.  Ease yourself back into life and note what felt good and what was uncomfortable for you.  Keep doing these small things until they become much less stressful before you move on to bigger outings or larger gatherings.  It will be much easier to get overstimulated as you are re-entering, so don’t expect yourself to make up for lost time by making too many plans or promises.

If I take a step back, it’s almost amusing at how many of the simplest skills I have to relearn!  I’ve had a lockdown wardrobe that is pretty much a comfort based selection and a routine that moves much more slowly.  I forgot what outfits I used to wear to go out, what jewelry was my go to, what route I took to get to the coffee shop and what to say to people even in the simplest of circumstances.  It just shows how our brains work that after so many years of my life, after just one year of doing it a different way, I have unlearned so much!  But the good news is generally how easily it will come back.  I did feel a great sense of relief after my day at work, knowing the next time will be easier.  In fact, I’m planning to ask if I can book office space (the medical staff are now using most of the offices to socially distance with patients) once a week, just to build up my professional muscle again.  This muscle has definitely gotten a bit soft in the past year, working from the comfort of home with my kitten sitting in my lap all day.  If only there was a way to take him with me as my re-entry emotional support animal!

My last post left us in the Action Stage (Stage 5) where we had finally made our change.  But no matter what you’re trying to do, if the change you’re making is challenging, you will have slip ups.  That’s precisely why Stage 6, Relapse, is actually considered a stage of change, because it’s such a natural part of  the long term process of change.  Although it’s listed as the final stage in the Transtheoretical Model, the model is actually a circle, where Relapse flows directly back into Stage 1.  This circular shape is in recognition of the continual cycle of falling off and then getting back up on the change horse, so to speak. Change will always have its ups and downs and backs and forths. Today’s post is about how to cope with relapse in order to minimize its detrimental effect on your long term goals.  In other words, how not to give up after a setback!

In most cases, it’s not the relapse behavior itself that is so costly, but the negative effect of the relapse on your self esteem and confidence.  After a backslide into old behavior, it’s natural to feel disappointed, frustrated, and like you’re a failure.  But it’s these exact feelings that actually perpetuate the relapse behavior, research indicates.  People get so down on themselves, they give up, labeling themselves as too weak or too lazy, or some other character flaw that is permanent.  This negativity actually fuels the relapse behavior, as you get into an “Oh, **** it” mindset and punish yourself with harsh self criticism.  This continued self criticism further sinks you down into the dark hole of relapse.  

The biggest factor in how well people overcome a relapse incident or episode is how quickly they can get back on track.  The longer the old behavior continues, the harder it is to get out from under its grip.  An important factor is your perception of your relapse and what you attribute it to.  If you declare it happened because you are a no-good loser who will never be able to be successful, it will be harder to get back on track.  If, however, you attribute it to a bad choice, a stressful event without the proper coping tools available, or a slip due to a temporary situation you can keep the problem to a fixable solution rather than a character flaw that dooms you.

When and if you do have a relapse, try to distance yourself from it as if you were a scientist investigating a problem.  Create reasonable hypotheses regarding what happened by looking at the evidence, such as what triggered the behavior, what coping was needed, and what could have prevented the behavior from happening.  As best you can, develop a rational explanation to counter your emotional self sabotage. Begin to problem solve and plan for the future. Understanding what happened is about creating forgiveness so that you can let go and move on, not about making an excuse so that you can keep going in your relapse.  Think of relapse as a good time to evaluate your self care.  We tend to be most vulnerable to slipping back into old habits when we are stressed, tired, lonely, depressed, or too busy to be thinking about our values and our choices.  Sometimes it helps to think about emotional relapse as separate from the actual relapse behavior.  When we stop caring about ourselves, we emotionally give up and slip into circumstances that make us more likely to engage in the behavior we have been careful to avoid.  In AA there is a saying, you take your first drink before it ever crosses your lips.  Warning signs might be isolation, avoidance, rationalizing, and romanticising how life used to be.

And this is how we get back to the beginning, by reaffirming our need and desire for a change, reassessing our motivation and our skills.  Try to use your relapse as good energy to recommit yourself rather than a drain on your energy in self punishment.  While relapse is never pleasant or desired, by incorporating it as a part of the change process, you can take the powerful sting out of it that may lead you to give up.  If it’s planned for and an expected part of the process, it makes it easier to move past it.  Letting go of shame is critical to moving into a recommitment.  This is why it’s often important to tell someone about your setback, airing it out in a way that tends to take the secrecy and darkness out of the incident.  It also allows you to gather support and guidance in getting back on track.

After a relapse incident, it’s often a good idea to write a letter to yourself about what happened.  It helps to clarify how you are feeling and to let go of the negativity.  It’s also a great reminder of what it feels like to be in the situation.  There is nothing better than reading your own words to remind yourself about the pain of relapse as a tool to keep it from happening again!  For example, now that I am older, I motivate myself to keep moving by remembering how hard it is to get back into shape!   It’s often the thought of what it takes to start over that can keep us from having the need for it.  So think of your Relapse Stage as an opportunity for learning.  Like most things psychological, the more you can name it, the better you can tame it!

RELAPSE (stage 6) – reengaging in old behavior pattern. Task: Learning from relapse what will help deter or minimize a relapse the next time.

So congratulations! We did it! In my last post we took Action and made our change after time spent avoiding, deliberating, and preparing. And now we are in Stage 5, the Maintenance Stage. Sounds so easy, doesn’t it? Just maintain, keep the status quo, as if the work is done. But unfortunately, as we all know from past attempts at change, it ain’t all that easy. The Maintenance Stage is hardly a passive “just keep it up” phase. It actually involves a lot of work and a continued hypervigilance to avoiding the dreaded relapse. So in this post, we’ll take a look at some strategies to keeping on keeping on.

Maintainers must learn to successfully navigate temptation.  It helps to remind yourself of the progress you’ve made and acknowledge the time that’s gone by as a way of keeping the momentum.  Mark milestones, such as days of the new pattern – the first week, the first month, etc.  Reminding yourself of the work already put in helps to avoid the temptation to break the chain.  It’s also important to remind yourself of the importance of the change, as this may tend to fade over time.  Keeping tangible reminders of the meaning and significance of your change can be good motivation.  Sometimes just having a bracelet with a word on it, posting a list of why you are changing on your desk, or having a meaningful photo in your line of site can be a good pick me up at a low point.   

Maintainers need to be adaptable. You must be able to reformulate the rules of living and acquire new skills as needed to deal with unexpected challenges as they present themselves.  For example, a vacation or a change in routine can throw you a curveball.  In order to maintain a change, it requires planning ahead, anticipating where you will most likely face challenges, and then coming up with workable strategies to adapt to them. You might need to pack some of your own food, some coping tools (such as a book, a knitting project, or other distractions), or do some research about resources that will be available in your new environment.  For example, you may want to find a place you can go to get exercise or attend an AA meeting on a trip. Whatever the need is, to maintain your change, how can you take care of you in your new situation? 

Maintaining requires a lot of patience with yourself, as it takes time to let go of old habits and replace them with new ones.  It can be discouraging when you’ve stuck to a plan for so long to  be so easily pulled into desires that you thought you had put behind you.  There are some definite warning signs to look out for in order to Maintain.  Beware of the word “just.”  It usually represents some sort of way you are trying to fool yourself.  “I can have just one cigarette,” or “I can skip my medication just for a few days,” are some examples of how our own mind can play tricks on us!  Just really?  And also beware of romanticizing your old behavior.  “Remember when I drank tequila?  I was so funny!”  Or “I was able to get so much more done when I went to bed at 2 am.”  You tend to remember a distorted image and forget what led you to need to make the change in the first place.  It wasn’t worth the cost, whatever the habit was, as you had decided to make a change.  Remind yourself about the flip side of the coin and why you had decided the old way didn’t work.  

And finally, Maintaining requires assertiveness skills.  There will be countless people who will pressure you to go back to your old habit.  “Oh, you don’t like my cooking?” or “Come on join us, what’s the harm.”  It can be hard to say no and risk feeling like you are rejecting someone or refusing a kind gesture.  But Maintenance involves a commitment to yourself.  It involves internalizing permission to put what you determine is healthiest for you above what someone else may want.  Maintainers have to navigate how to set boundaries that are flexible enough to get along in the world, but firm enough to keep true to their goals.  See what I mean?  Maintaining is indeed a lot of work, but the good news is, you get a big reward.  Not only do you get the change you desired, but you get the confidence and pride that comes along with being successful at it!

Maintenance (Stage 5) – having reached a goal now taking steps to maintain it Primary Task:  Developing necessary skills to keep the change and avoid relapse