A pandemic is a whole other ball game. We are dealing with social isolation, government incompetence and cruelty (at least in the US), institutional/medical racism, etc. This pandemic is adding so much extra stress into our lives. Stress isn’t a light-weight thing. Long term stress weakens our immune system, makes us physically sick, messes with our ability to sleep, gets in the way of thinking clearly, triggers traumatic reactions, creates negative psychological effects, worsens mental health symptoms (anxiety, depressive symptoms, panic attacks, manic symptoms, increase substance use disorder symptoms, nightmares/sleep disorders, suicidal thoughts), etc. And at the same time, we are also dealing with loss. The loss of certain freedoms, disruptions of routines, loss of lives, loss of jobs, etc. The loss of physical contact and literally being close and social with people. We now in less than a month have had to self-quarantine and keep 6 feet way from people for social distancing. Many people have been avoiding loved ones who are older and/or immunocompromised for their safety, just in case they are carriers of the virus. This is the kind of sudden loss that turns someone’s entire social support system upside down before they can even process what they actually lost. Some people have had to return to toxic/abusive households and are struggling to survive everyday.

This pandemic has had huge, lasting effects on our physical health and mental health and the physical health and mental health of others in our lives. I am updating my previous safety plan given the current circumstances. The text is black is my original plan, which still has great information. And the red text is some COVID-19 pandemic additions I’m adding. A good safety plan is always up-to-date and reflects what’s going on in your life. It has to be useful or it’s a refrigerator decoration. So, time for an update.

Step 1: Identifying the situation. What are some signs that let you know you’re starting to feel hopeless, sad, frustrated, etc? Do you feel it in your body? Do you feel tired all the time? Do you lose your appetite or eat more than usual? Or is it more in your head/thoughts? Do you get racing thoughts, for example? Mindfulness techniques [Here’s a piece I wrote about how to find the find one for you] are great ways to get a clearer idea of how you’re feeling if you aren’t sure.

Some COVID-19 pandemic specific signs: extreme fear of illness, difficulty coping with illness in yourself or their loved ones, isolation felt from social distancing, loneliness, family conflict, etc. and that on top of the normal warning signs. Use mindfulness techniques and self-reflection to check in with yourself.

Step 2: Self-soothing. What can you do for yourself to return to back to how you were feeling before? What are some things you can do to cope with these feelings/this situation? How did you get through difficult times in the past? What stops, if anything, you from you using these coping skills now and how can you get around whatever is in your way?

Like many people, some of your coping skills might involve being out in public with other people. So what are you supposed to do now? It’s probably time to think about ways that you can cope while staying indoors.
Some great suggestions I’ve tried and/or heard include:

• Make a weekly or daily schedule for yourself if you need structure
• Set alarms to remind yourself to eat (similar suggestions here)
• Take a time out by going to a different room, putting headphones on, meditating, etc.
• Mindfulness exercises like I mentioned earlier
• Do an activity to change your physical state like showers, exercise, holding ice, weighted blankets, getting a hug, getting dressed up, etc.
• Distract yourself with reading, video games, TV/movies, cooking, knitting, writing, dancing, etc (things that don’t stress you out)
• Donating money, food, skills, resources, etc directly to individuals and families in need to help you feel like you are making a difference

Step 3: Who your people? (I said what I said). Being able to self-soothe is important, but also don’t be afraid to reach out to trusted people in this difficult time. Who can you ask for help? And what kind of help do you want from each person? Do you wanna vent? Do you need to leave home for a couple days? Do you need someone to make sure you eat? Do you need help going to the Dr? Do you need help with classes? Do you need money or transportation? Do you need help filling out paperwork? Do you need someone to babysit your kids for a couple days? If your social circle is fairly small, what social agencies are in your area that provide free or low cost services? A lot of community organizations can provide resources or referrals to free or low cost assistance that many people are not aware of.

Ask yourself what you need every so often throughout this time (other than being touch starved which is definitely going to become more of a thing as this pandemic goes on) and how you can creatively meet those needs.

Example of ways to be socially connected during this time:

• Call and video chat with friends and other loved ones
• Video parties and happy hours
• Leave food and stuff at each other’s doors
• Virtual activities like museums, church services, games, dance classes, etc
• Virtual support groups and peer support groups

Step 4: Emergency services: Do you feel comfortable calling emergency services? What hospital would you want to go to in a worst case scenario? It’s better that you choose than to have a stranger choose for you. How would you get to the hospital if needed? Do you have any suicide hotlines handy (See the post on depression here for a brief list of hotlines at the end)?

Adding telehealth sessions with therapists, psychiatrists, etc. here as remote support options during this pandemic.

These are not normal times and it’s ok to not be ok. There is a LOT going on right now and that’s not even counting whatever is going on personally for you. It’s ok to acknowledge of realness of the whole situation. Not only is that good for your mental health, it’s good for figuring out what you need and want during all this. Keep your loved ones and your people close to you even if you have to be physically distant from each other. Who is your community? How can people come together to fill the gaps that the government is purposefully neglecting? How can we support each other through this, especially those who are disabled, who have lost jobs, and/or those who are homeless, etc.? Friends checking in and supporting friends, families of all kinds coming together, and communities coalition-building. People can also take this time to build virtual social circles that hopefully can include people who live in your local areas to provide support in an emergency scenario. Maybe donating to individuals’ crowdfunding or to grassroots organizations if you have the means. It’s time to be kind to yourself and to think creatively of the ways that we can stay safe and well, individually and communally in a time when capitalism and white supremacy obviously wants us to be sick and alone.

This is a Part 2 of a 2-part series about change, written using knowledge about the psychology of change so that we can all be on the same page about the actual steps of making a change in your life, what it means to do the work of change, and how to see if someone is fronting to avoid actually changing and being responsible for their actions. Part 1 explained what motivation is, what the process of change generally looks like, and how to give a meaningful apology. This Part 2 covers important parts of the planning, action, and maintenance stages in the process of change, explained in Part one: 1)what accountability is and what makes it a key to true change, self-reflection, and 2)learning how to set realistic goals/plans for change. My goal with this Part 2 is to: Help people be able to see if someone is actually doing the promised work of change and Put a spotlight on accountability. I want us to give just as much shine to accountability as we do to forgiveness. Because from a psychotherapy and mental health point of view, forgiveness is NOT needed for healing. At all. Someone can definitely heal and live a full life without ever forgiving the person(s) who have hurt them. But the flip side isn’t true. Accountability is SO IMPORTANT for healing. Without accountability, true healing and change will never quite be possible. So many people see change as something that happens to someone so they can be passive and watch change happen. But that’s not true. Change is active, both for individual people trying to make changes in their lives and also for the community as a whole.

“It’s Done. Let’s Just Move on.”

So they’ve apologized to others and have forgiven themselves, now it’s time to move on, right? Actually, no. Change is not about “moving on”. Moving on implies putting things behind you. And when someone puts something behind them, with time, they start to forget about it. Out of sight, out of mind is real. So instead of “moving on” or “moving past” something, change is actually moving towards. The person wanting change now needs to start walking the walk: making the sometimes uncomfortable moves towards change and community-healing. Because yes, their actions do have an effect on the people around them and, on some level, their communities.  Change is not about looking good in public, getting people to forgive them so they can feel better/comfortable, or getting back to the way things were before as quickly as possible, etc. That’s not the kind of motivation that leads to lasting change. That could be what first pushed them to think about changing, sure, but after awhile, that’s not going to be enough to keep them going when no one is clapping or even looking at them anymore. Again, unless they are changing because they want to deep down and they see the change as worth it to them personally, the change is not going to last. Walking the walk isn’t always going to feel easy or good. It’s gonna feel like hard work sometimes because that’s what it is. 

Action and Accountability

Forgiveness

Forgiveness is nice. Someone forgiving themselves when they are ready to change is very important. I will say, though, that I see a lot more energy given to rushing towards automatic forgiveness. ESPECIALLY if this is someone with social power, someone most people like, and/or someone who makes popular music/art. Rushing to forgiveness messes with the process of change for 2 reasons. First, it assumes that forgiveness is a mandatory part of the process of change. And it is not. Forgiveness is each person’s choice. It’s not even a required part of healing. Someone could have pushed themselves, worked hard, and transformed themselves into a totally different person and it is still someone else’s prerogative to not forgive them and/or to never want to deal with them again. And someone can heal and live a full life without ever forgiving the person(s) who have harmed them and/or harmed others and that’s fine. Not everyone will forgive. Some people won’t be allowed in certain spaces as a direct result of something they have done to someone else. That’s called respecting other people’s boundaries.That’s also the consequences of their actions and they gotta deal with it. Could someone feel upset, frustrated, tired, etc. because of these consequences? Sure. And if they need to express those feelings to people, they should process those feelings with a consenting friend and/or therapist. That is exactly where those feelings belong. 

What is Accountability?

Less talked about than forgiveness, but more important to me, is accountability. Forgiveness is nice, but accountability is a key to long-lasting change. People feeling as if they are not accountable to anyone is one of the reasons for the abuse, neglect, etc. we see in the government, at our jobs, in our schools, in our communities, in our churches/places of worship, in our families, in our romantic relationships, in our friendships, etc. There is so little accountability going on throughout people’s lives that many people don’t seem to be clear on what accountability is or what it looks like in the real world. To be accountable means that someone is holding themselves responsible and/or is being held responsible for what they have done and/or for what they were supposed to do. Being accountable is also about accepting the consequences of your behavior and choices.

Accountable to Who, Exactly? 

We are all accountable to someone or something in our lives. From the time we are born, there is usually SOMEONE who can check us. Whether it’s parents, teachers, older peers, bosses, landlords, the IRS, etc., at some point, everyone has to answer to someone else. A person, who is serious about changing, holds themselves accountable to the people harmed. Accountability includes reparations. Specifically listening to the person(s) who have been harmed and basing your plans for change on what they need and don’t need from you. Being accountable means being committed to not repeating that behavior without demanding forgiveness and/or expecting rewards for changing. And to do that, you have respect the boundaries of other people and accept the potential social consequences of your actions. Another part of reparations is working on learning new ways of acting/thinking/speaking to take the place of the old ways. So when someone is facing (constructive) criticism about their lack of change and/or not being willing to learn why what they did was messed up, they are refusing to be held accountable and are refusing to really change.

Another level of accountability is being accountable to the community (I plan on writing a separate piece about community accountability later this year). In a better world, it is the community’s job to provide safety to its members. Close friends, relatives, people that the person trying to change respects, etc. should acknowledge the harm done and tell the person they are responsible for resolving it. Instead of what usually happens: Enabling their loved ones, trying to make the work of change as easy as possible, and/or making them feel comfortable with not changing at all. When people are not also held to higher standards by their loved ones, peers, and community, they feel like they can avoid the work of change. Where is the push to even start contemplating change when everyone is acting as if the person hasn’t done anything wrong? Part of community accountability is checking in people’s growth and being willing to receive that check-in. Holding yourself accountable to the community means being willing to be accountable for your actions and your words from the past and in the future. Strength isn’t just somebody saying something with their chest. It’s also to being answerable for what they do and the effect it has on other people. No gaslighting or lying. Just standing up and being willing, not to move on, but to continuing to move toward change by accepting feedback and constructive criticism. Similar to how I described the healing power of boundaries in the Boundaries 201 Part 2 piece, personal and community accountability go a very long way in making positive long=lasting change possible. Accountability creates the right environment for change and encourages more growth in the future. Without personal and community accountability, people eventually won’t trust each other and strong community ties are not possible in that situation. Accountability is part of the work that keeps people and communities feeling safe. And safety and trust in each other is at the core of powerful movements and revolutions.

Working on Yourself

Self-Reflection:

So what does the work of change actually look like? Where does someone even start? I think one of the first things to do is to make time for self-reflection. And I’m not talking about taking 10 minutes to think about why this person was right and that person was wrong. Assuming by this point, you are at the place where you want to make changes for yourself, it’s not about what other people did anymore. Your main focus should be on yourself. I’m talking about setting time aside time for days, weeks, possibly months, to really dig into everything that happened, the role(s) you played, how your actions affected others, etc. You can use my life reassessment piece here as a starting point (it includes links to my piece on mindfulness so check that out) to help figure out how to start the process of taking stock of your life. Taking the time to look at your life bit by bit in an honest and deep way will give you a clearer idea of how to move forward without repeating the same life lessons over and over again. 

The process of self-reflection will take as long as it takes. Don’t rush it. This is a difficult process and many people prefer to rush through it to get to more feel-good parts, like a glamorous redemption/prodigal son story. But it’s the journey that’s important here, not to be cheesy. But it’s literal facts. If someone rushes through their process just so they can get back to the part where everyone likes them again, it’s a fake peace. They didn’t acknowledge that something in their life isn’t right. They didn’t come face to face with the need for change. Without acknowledging and understanding the entire realness of what happened, they can never truly apologize and feel sorry for their part in what happened. And if they don’t feel sorry, they will not change. That’s why I believe that no one should accept any kind of apology (or even worse, accept a non-apology) just to “keep the peace”. Again, that’s a fake peace and it won’t last. 

“I Mean, At Least I’m Honest”

Someone acknowledging what they did and/or “being honest/blunt” about the things they do that hurt people (low-key or high-key) is not enough. The work doesn’t stop there. No applause. No pat on the back just for honesty. That’s less than half the work. It’s good that someone knows themselves. Y’all know I love a mindful person. But my next question every time is, “Ok so now that you know you’re like this, what are you planning to do about it?” Because if the person doesn’t plan on doing anything serious to change in the long term, they can hurt someone just as badly as someone who isn’t aware of themselves at all. If someone feels like they aren’t able to get as deep as they need to on their own, that is probably a sign to start looking for a therapist for a professional outside point-of-view. Vet the therapist to make sure they already have the values you are trying to build in yourself. Just…just saying.

Setting Goals and Making Plans

Someone has been reflecting, is becoming more and more mindful, possibly working with a therapist, and feels ready for the next step, so what’s next? It’s time to take what you have learned about yourself (and are continuing to learn about yourself because self-reflection shouldn’t stop) and decide what needs to be done to change. This is where SMART goals come in. I learned about this from working at community health organizations for years and this is a great way for people to organize themselves and make sense of where they want to go. SMART goals (and objectives) are like the compass for change, making sure someone doesn’t lose track of where they are and where they are going. SMART stands for Specific, Measurable, Achievable, Relevant, and Time-Bound.  

Specific

Meaning each goal focuses on 1 thing the person wants to improve. Saying “I wanna be a less angry person” doesn’t do anything here. It’s too general. A more specific goal would be “I want to stop getting into arguments with my coworkers”. Being clear and specific with goals is very important to keeping a person’s motivation going. If a goal feels too big, impossible, etc., people are more likely to burn out or give up on changing. Keeping the goals specific and easy to keep track of makes them easier to accomplish. 

Measurable

Meaning can someone measure their progress with this goal and how will they know when they have accomplished this goal? That 1st goal (“I wanna be a less angry person”) is too general to measure progress. How would someone define “less angry”? What would that even look like? The 2nd goal (“I want to stop getting into arguments with my coworkers”) is easier to measure someone’s progress with. Someone can literally track how many arguments someone is getting into and watch as the number goes up or down. 

Achievable

Meaning how realistic the goal is, depending on the person’s situation. How do they plan on getting this done and what do they need realistically to do this? Do they need to start taking classes, buy some books, consult with some people, etc.? 

Relevant

Meaning is this goal even related to the thing they want to change? Is this goal actually helpful to the person’s growth and/or to the person(s) affected by their actions? Is this the right time for this goal? 

Time-bound

Meaning there’s a realistic deadline by when either the goal will be achieved or someone will check in by that time to see what to do next. What can the person do today to make working towards this goal easier tomorrow? Every SMART goal has at least 2 objectives (mini goals) to break down the goal into smaller, easier steps. 

The great thing about someone organizing their goals for change into something like SMART goals is it helps them organize and make sense of a process that can feel very huge and overwhelming. Taking the time to plan the next steps sets a solid foundation for change and helps a person remain accountable to themselves and to the people around them. And someone organizing their life into SMART goals, in general, is a great way to approach other things they want to accomplish in their life.

There is always going to be someone promising change or promising to change. And it’s important for us to be able to know how to recognize this process/work in others when it’s time to hold people accountable for their actions. Awareness is always key. And taking the time to stop and critically think about a situation is 1 of the tools that will set us free. Change is a process that lasts someone’s whole life and knowing more about the process of change and what change looks like will help you figure out if someone is really walking the walk. Remember that motivation for true, long-lasting change comes from within and with the understanding that 1)forgiveness is not mandatory and 2)that there are justifiable social consequences (For example: other people setting their own personal boundaries aka “cancelling”) that happen as a result of their actions. We as individuals must hold ourselves accountable and push ourselves to grow everyday towards the better future we want. And we as a community must hold each other accountable so we can create the environment for the growth and trust in each other that makes the true change we fight for possible.

Thanks for reading. The next post will be a Reader’s Request on Sunday 4/14/19, covering 1)estrangement after you’ve cut off contact with family, and other people who were once close to you, 2)mourning the lost relationships of still living people, and 3)how to manage the people in your life who still have connections with those estranged people.

The ending of any relationship is hard, but it feels especially difficult and unique when it’s the professional relationship between a client and a therapist. Whether the relationship was new and you were just feeling them out or you’ve been seeing them for years and they know your everything…there’s just something so unique and special about this kind of professional relationship. The dynamic/working relationship between client and therapist is so powerful and amazing when done right. It’s so intimate and yet, again, if done right, there are boundaries in place that create a special space where people, as clients, can feel safe enough to really get raw and real and do the deep work that needs to be done to change their lives. That all said, there are solid reasons to think about ending your current relationship with your therapist: there’s no chemistry, the therapist said something offensive and you want out, you’ve been working with them for awhile, feel like you’ve been in a good place, and want to reduce sessions, etc. Knowing if it might be time for a change and/or what kind of change is needed can feel very complicated. I wrote this piece to help people who feel like they need a change or like they have hit a plateau in therapy and need some options of what they can do at this point. FYI: Answer the reflection questions throughout this piece like you’re having a conversation with someone you trust. That will help you answer with enough detail to get the most out of it.

Checking in

Reassessments:

If you’ve read at least 2 of my pieces in a row, you already know that I’m a huge fan of self-reflection, checking in with yourself, and having a deeper understanding of yourself. If you need some help, here is my life reassessment piece where I explain how to look at your entire life and get a solid sense of where you are so you can figure out where you need to go. Checking in with yourself every 6 months to a year wouldn’t hurt. Now, if you have a therapist, you should be checking in formally via a reassessment approximately every 6 months to compare thoughts on your progress and to check on your treatment plan (your plan and goals for therapy). This is important because you want to avoid losing track of what you came to therapy for and losing direction. If you have ever found yourself going to therapy, but having no clue what you are doing there, or how it’s even helping, or what the point of it was, etc., that’s a sign that the direction of therapy was lost at some point.

Questions to Reflect on:

1. Does your therapist check in with you about how therapy/your treatment is coming along?
2. When was the last time you saw your treatment plan?
3. How would you describe your treatment plan (your plan and goals for therapy) in your own words?
4. Where would you say you are in your treatment as compared to where you were when you had your first session with this therapist?

Reassessing With Your Therapist

So you did some thinking and reflecting on your own, collected your thoughts a little bit, and now it’s time to bring this to your therapist. One way to start this conversation is asking when the next reassessment is or asking to go over the treatment plan and talk about your progress. This should lead to a conversation where you, with the help of your therapist, compare where you are with where you wanted to be by this time. And this is also where you reflect on the work that has been done in therapy up to this point and even talk about how the dynamic/relationship between you and your therapist has affected your treatment. In psychotherapy, this is called metacommunication. Metacommunication is when you and the therapist both take a step back and talk about your therapeutic relationship/dynamic together and it’s effects on your treatment/work in therapy. A lot of the time, a client and therapist talk about the other parts of the client’s life, but like any other relationship, it is important to check in from time to time. Metacommunication can sometimes feel uncomfortable, but it is a necessary part of the work. If your professional relationship with your therapist has issues, however big or small, at some point, it is going to start having an effect on your work together and your experience of therapy as a client. And nothing should get in the way of that time. That’s your time. And it should be used making the best of what therapy has to offer for you. Anything less that takes away from you and your growth.

Ideally, your therapist should welcome the opportunity to talk about your professional relationship. We, as therapists, are trained to do this anyway and we have been trained to see this as the learning opportunity that this is. I’m going to wish for the best and think that your therapist will do as they were trained…but if they don’t, and you asking about your progress in therapy turns into a power trip, then that experience taught you something about this therapist. And that kind of information, that bit of knowledge, is important in deciding the future of your professional relationship with them. Like I said, any therapist who’s really about it will use this metacommunication time to see if your treatment needs to be updated (does something need to be taken out of treatment, need to be changed, and/or do you need something new?) or if you need to reduce sessions to monthly, etc. This is a great time for the both of you to work together and get to the bottom of what’s going on for you.

Questions to Reflect On:

1. Is there something you wish you could receive more or less of from your therapist?
2. How do you feel about your dynamic with your therapist?
3. What kind of rapport/bond do you have with them? What vibes do they give you?
4. How does your therapist make you feel?
5. Is the kind of treatment you are currently experiencing still working for you or do you think you need different kinds of psychotherapy or a different kind of therapist?

When It’s Over

If you are in the situation where you are not getting want or need in therapy and feel like you need another therapist, don’t be afraid to move on. Unless you are legally mandated to be there with this specific therapist, nothing (other than money) is holding you. I know it can be tiring to keep window shopping for therapists. The effort is worth it though. The healing power of therapy won’t be fully there if the relationship between client and therapist isn’t right. So if you don’t think the relationship is worth trying to fix, then it’s time to move on because you aren’t going to get anything out of therapy otherwise. Can’t drink from an empty cup. You checked. The cup is empty so it’s time to move on. For a lot of people, the idea of breaking up with your therapist feels like a big deal. And it is. But at the end of the day, you are a customer and they are providing you with a service. Again, unless you are mandated to work with them, you are well within your right to find a therapeutic relationship that has more of what you are looking for. Ideally, it would be cool if you and your therapist could have a final session to process the termination, i.e. the ending of the relationship, but if what happened makes you never want to see the therapist again, i understand. It’s similar to what I talked about in the piece here about setting boundaries with toxic people in your life, setting boundaries requires you to have compassion for yourself and your needs. Seeing your unhappiness as something worth dealing with even if many people have ignored it in the past. Maybe it is time for a change.

The ending of relationships doesn’t always have to be negative. You and your therapist could have clicked in a major way and y’all could have spent many sessions, putting in some serious work on your wellness. So why end it? Sometimes you want to reduce your sessions or end sessions because you feel like you’ve been in a good, stable place for a while. Maybe you have been working with this therapist for months and/or years and you both looked at your treatment plan and all the short term and long term goals you set for yourself have been checked off the list. And let’s even say you both tried to brainstorm some new goals and couldn’t really think of anything serious. That’s a solid sign that you’ve probably gotten enough from from therapy at the point in your life. This is a great topic to bring up in some metacommunication with your therapist. Use some mindfulness techniques, reflect alone, talk about it with trusted people, with your therapist…if you feel like you have gotten enough from therapy at this point, it may be time to start reducing sessions from every week to 2x a month, etc. until you reach your agreed upon last scheduled session. The termination process is ideally an extended mutual process between therapist and client where time is dedicated to process the end of the current professional relationship (as a loss/end, as a beginning/new chapter, etc). It’s a bittersweet time. You and the therapist are sad to see this phase of the relationship end, but also looking optimistically towards the future.

After the Goodbye: Starting Over & Booster Sessions

Having to start over again can be so frustrating. And tiring. I feel that. This might have been the 3rd or 4th therapist you’ve tried and you’re wondering if it’s even worth all this effort.

It is.

And I’m saying that both as a psychotherapist and as someone who has been in therapy personally. Finding a therapist who you can work with can really make a huge difference in your life. Having the space and the opportunity to work through things that have been sitting with you for months and/or years is life changing. Like any other service in this capitalistic society, you unfortunately may have to continue to search and sort for awhile until you find the right therapist for you. It’s worth the search. (Maybe I should write something about how to tell if a therapist is a good fit in the first 3 sessions…)

Now, if you had a great relationship with your therapist, just because the current relationship is ending, doesn’t mean that you will never see your therapist ever again in life. It doesn’t hurt to have a therapist on tap for booster sessions. It’s nice to know that you can always come back and that you have someone really there in your corner to help you figure out how you want to move through life. Therapy and mental health and wellness is a continuous, life long process just like physical health. Best case scenario, you could go to therapy regularly with a trusted therapist like having check-ups with your Dr, except focusing on your mental health.

Being stuck in a rut, stagnation, is opposite of growth and healing. As I mentioned previously, it is always important to check in with your therapist if you feel like you are no longer getting (or have never gotten ) anything out of therapy. An ethical therapist would appreciate the check-in and would see this as an opportunity to update the treatment plan with you to make sure that your work together continues to be helpful. Regardless of the reason or specific situation, there will come a time when professional relationships between therapists and clients have to end. Hopefully this piece helped to make starting the process of saying goodbye feel less complicated and explained some of the options you have in these kinds of situations. These endings have the potential to be the healing new beginnings you have been really needing and looking for.

Thanks for reading. The next piece on Sunday 3/10/19 will cover the process of change.

I’m sitting back and letting myself be in awe for a moment at how messed up the world is on so many levels and in so many areas that I even have to write this piece. The same way that I mentioned in the drugs 101 piece here that we often have to rehab ourselves, very very often, we are put in situations where we are also the ones literally saving our loved one’s lives. Many people are out here doing heroics for themselves and their squads with little to no support from medical and mental health professionals due to financial reasons, systemic and interpersonal bigotry, etc. Queer people & people of color (ESPECIALLY queer and trans people of color) are often doing the healing work in our own communities because there’s often no culturally-competent, ethical, and affordable providers around. This piece covers how to support your friends and loved ones as they work to recover right after a trauma and/or a crisis while also trying to find appropriate medical and mental health professionals. You are not their therapist or their doctor, but you can give them short term support while they are trying to lock down long term professional help. This is definitely a in the mean time and in between time kind of piece.

Before I get into crisis intervention, I’m going to list and link a few related pieces that I think you should read before doing this kind of emotional, psychological, physical, etc. labor for your loved one(s). One important thing to learn and never forget before taking on this kind of work is: The best way to help and the best place is start is ALWAYS asking the person in crisis what kind of support they need and going from there. Your role isn’t to save them (savior complexes both take the humanity out of the people you are trying to help and treat them like children. They are grown adults. They don’t need you to tell them how to live or need you to baby them. They aren’t SIM characters. They just need a boost while going through a rough situation like you would in their place). One more time: Your goal is NOT to rescue them. Leave that savior mess at the door. Not only will taking on that unnecessary burden burn you out, frustrate you, and possibly turn into resentment over time…it’s also not what the person in crisis needs or probably even wants. They may not know what they need at first, but go at their pace. This isn’t about you. It’s not about you “wanting your friend back” as soon as possible so you can hang out like you used to. It’s not about you wanting to see them happy because it makes you feel better. This is about their healing, at their pace, with them at the lead. 

• Boundaries 101: This piece covers what boundaries do and how to start setting solid personal boundaries. This intro piece to how to set boundaries will help you be able to be there for your friend(s) while also saving enough physical and emotional energy for yourself.

• Boundaries 201 Part 1: This post explains how to take the ideas and skills learned in the intro to boundaries piece and how to apply them to your family life and other close relationships. Specifically, how to set boundaries around toxic and/or abusive people in your life.

• Boundaries 201 Part 2: This Part 2 explains how to use boundaries as tools to make your relationships with your loved ones even stronger and longer-lasting.

• Mindfulness: This piece covers how mindfulness strategies and techniques can help you become more aware of your emotions and what’s going on in your body and mind. When dealing with a crisis situation, one might feel tempted to block out emotions and try to power through the crisis. This might be a decent very short term solution, but what happens when there’s crisis after crisis back to back in your life? Now, it’s been months and/or years of dealing with different kinds of crisis going on and you have no breaks. Pushing down your emotions doesn’t make them go away. They just come out in other ways like constant body pain, mood swings, poor sleep, poor eating, being easily agitated, high blood pressure, etc. Emotions and stress that are never handled can literally kill. 

• Suicide: A significant number of people in crisis can experience a wide range of suicidal thoughts/feelings: wishing to not be alive, wanting to fall asleep and never wake up, thinking about specific ways they could end their lives, etc. This post explains what suicide is, the difference between thinking about suicide and being at risk of actually doing it, bodily autonomy, and suicide prevention. Understanding what suicidality really is and what it really means will help you figure out how to give your loved ones the kind of support they need.

• Mental Health and Hygiene: This piece talks about the the impact that mental health can have on our routines/hygiene habits and practical suggestions for if/when you notice changes in your ability or your loved ones’ abilities to keep up daily routines. This may be very important especially in the beginning of the crisis situation. Being able to have empathy for the person in crisis and for yourself, a caretaker, is going to be incredibly important.

• Self Care: This post covers what self care is and how to build and maintain a solid, healthy relationship with yourself. Everyone involved is going to need to pay special attention to self care. The person in immediate crisis may need help finding and/or going back to the self care strategies they have used in the past. Caretakers will need to continue Investing in themselves and doing what they need to do to recharge and love on themselves while showing love and empathy to others. 

Establishing Safety

The first part of crisis intervention involves creating a safe space, both literally and figuratively, for the person in crisis. Depending on the situation, especially if they just experienced something traumatic, the person literally might not feel physically safe. They might look really alert, tense, and/or seem totally unable to relax. They might check the locks and windows at night. It may be really hard for them to fall asleep or stay asleep all night because of scary dreams, memories, anxious thoughts, etc. So an important first step involves working with the person in crisis (as a team. Don’t assume. Don’t put words in their mouth. Remember, they take the lead.) to create a space where they feel safe enough to sleep. 

Creating a safe space for sleep might include: 

• Creating a comforting nighttime routine to rebuild the sleep pattern/cycle

• Using nightlight or having a dark room, depends on the person’s preference

• Avoiding physical activity (that might take the heart rate up and trigger a panic attack in some people) or anything stressful right before bed

• Watching calming TV, reading, music, etc. around bedtime

• Warm baths or showers before bed

• Meditation and/or other kinds of mindfulness right before bed

These are suggestions, not hard and fast rules. Again, the person in crisis would know what is comforting and helpful for them. They might not be able to sleep alone. They might be afraid to be alone in general. They might need to talk about what happened a lot. They might need a lot of alone time. You can be their support in getting whatever they possibly need to feel safe and secure.

Coping Skills

Relatedly, your loved one(s) in crisis is going to need help dealing with what they are going through. This might look like helping them remember the ways they have coped with crisis situations in the past. A crisis counselor, at some point, would make a quick list of their past coping skills. That’s basically their current options right now. Are those coping skills still working? Does the person need an upgrade to those skills and/or brand new ways of handling stress, etc.? One of my former clients used to call his coping skills “tools in my toolbox” and I always thought that was a great way to describe it. Look at the different ways you handle stress and problems as tools that can be kept, upgraded, and/or replaced. The right set of tools can really make the difference while someone is trying to get back on their feet.

Some other suggestions on getting by on the day-to-day while in crisis include:

• Take it day by day with everyone being as gentle as possible with themselves and each other. And being forgiving of one’s limitations. You are possibly not going to be able to do everything in 1 day. You are probably not going to be able to move with the same energy immediately like you did before the crisis. And that’s ok. Healing takes time. How much time? However long it needs.

• Listen to your body and don’t force anything. Sleep when you’re sleepy. Eat when you are hungry. Move when you have the energy. I talk about how to strategize getting stuff done with your limitations (instead of despite your limitations…because working with yourself is just easier) in the mental health and hygiene piece I linked at the beginning so check that out for information.

• Many ppl use alcohol and other substances (legal & illegal) to help them fall asleep, coping with anxiety, etc. I would ask that, if you feel the need to get that kind of help, please try to keep in mind that it’s a short term bandaid and can only be useful while you’re getting other self care strategies together and/or using multiple other self care techniques at the same time. Whatever is making it difficult for you to sleep, etc. will still be there when the sleep medication/substance wears off. So take this time to start getting prepared to deal with whatever is at the root of your sleep, etc. issues. That way, if/when the side effects of the sleep medication/substance start to outweigh the all the benefits, you already have a Plan B in place.

• Talk to people you trust. Whether that’s your friends, family, therapist, social group, etc. Venting and/or working through your feelings and thoughts is an important tool for many people.

• Keep a journal (or notes on your phone/computer). It could be a helpful way of working through thoughts and feelings. It’s also a great mindfulness and grounding exercise. Crisis situations can often make people feel uncertain, confused, disconnected, etc. and being able to return to your thoughts and reflect on that at a later time (alone or with people you trust) can be a great way to clear up what is feeling foggy.

Safety planning 

Check out the depression piece here for more info on safety planning and links to resources/hotlines. This is a basic safety plan, with open ended questions to assist people in customizing their own unique plan for their situation.  

Step 1: Identifying the situation.

What are some signs that let you know you’re starting to feel hopeless, sad, frustrated, etc? Do you feel it in your body? Do you feel tired all the time? Do you lose your appetite or eat more than usual? Or is it more in your head/thoughts? Do you get racing thoughts, for example?

Step 2: Self-soothing.

What are some things you can do to cope with these feelings/this situation? How did you get through difficult times in the past? What stops, if anything, you from you using these coping skills now and how can you get around whatever is in your way? 

Step 3: Looking for help.

Who can you ask for help? And what kind of help do you want from each person? Friends, family, case workers, etc. Do you wanna vent or process feelings/thoughts/memories/nightmares? Do you need to leave home for a couple days? Do you need someone to make sure you eat? Do you need help going to the Dr? Do you need money or transportation? Do you need help filling out paperwork?

Step 4: Emergency services

Do you feel comfortable calling emergency services? If you don’t, who can you call that you trust to get you to a safe place? What hospital would you want to go to in a worst case scenario? It’s better that you choose than to have a stranger choose for you. How would you get to the hospital if needed?

The fact of the matter is, more often then not, marginalized people have to heal ourselves. And many times, especially for queer and trans Black people, it is friends and chosen families who are relying on each other to survive traumas, personal crisis, systemic oppression, health issues caused by environmental racism, etc. Squads and chosen families are out here doing their best to hold each other up long after biological families have failed them and all while the system works as it was intended to. Shout out to y’all. This piece is dedicated to the work you all do. And hopefully in this piece, you saw a healthier way to do what you have always been doing.

Thanks for reading. The next piece will cover termination: for people wondering if they should and/or how they should end their therapeutic relationship with their therapist.