Sunday, April 28, 2013

Guilt and self condemnation

I often work with patients who have endured some sort of trauma and who have blamed themselves for these events.  In most cases, it would be obvious to any outside observer that my patient is not at fault for what happened.  In fact, many of my patients have been told on multiple occasions and by many people that they are not to blame.  Still, they continue to blame and then condemn themselves.  The most common example of this is sexual assault.  Patients often blame themselves for not screaming louder, fighting harder, or somehow resisting more vehemently.  Or they insist that they "should have known" the person was a rapist and stayed away from him. 

Then there are the patients I encounter whose actions did play some sort of role in the outcome of their traumatic experiences.  I have never had a case like this that was completely cut and dry, i.e., the patient's actions were the direct cause of a negative outcome.  Keep in mind that most of my patients are military service members.  So an example of this type of situation might be as follows: A patient is in charge of some team or unit of service members.  He plans some sort of mission or decides upon a particular course of action, which his team or unit then implements.  Someone in the team/unit gets hurt or killed during the mission.  The patient blames himself because he planned the mission and selected the people who participated in it.  Of course, the patient did not plant the bomb or fire the gun that killed his teammate.  Still, he feels responsible.

Self blame inevitably causes suffering.  A person's thoughts are often consumed by their traumatic experience/experiences.  They replay the event in their minds over and over again in an effort to identify what they could have done differently that would have led to a different outcome.  They initially condemn their actions but over time end up condemning themselves.  Often they begin to hate themselves.  As self-loathing grows, they withdraw socially and isolate themselves from others.  They frequently become depressed.

Self-blame also keeps a person stuck.  When a person blames himself for some traumatic event, everything about the event becomes frozen in time.  The person's memories of and feelings associated with the experience are stored in their mind and body in their original form.  When the person attempts to process the event he ends up condemning himself.  It doesn't take long before he decides to stop trying to process the event.  He tries to bury the emotions and memories.  This is, of course, impossible.  At some point, the emotions and memories rise to the surface (e.g., when the person sees something that reminds him of the event), as intense and as vivid as they were on the day the traumatic event occurred.  Most people respond by redoubling their efforts to suppress the thoughts and emotions, which may work in the short term but will eventually fail.  And thus a self-defeating cycle emerges.

If self-blame has such obvious negative consequences then why do it?  While the costs of self-blame are many, it also provides a certain benefit; it enables a person to maintain a sense of control.  If I accept that something bad happened that was completely beyond my ability to prevent or control then I must accept that something terrible could happen again at any minute and there is nothing I can do about it.  This is, of course, technically true.  It is, however, quite scary.  How do we live in a world where we cannot keep ourselves safe? 

If, however, something terrible happens and I blame myself for it then I can prevent the bad thing from happening again by changing my behavior in some way.  In other words, if it's my fault then I can fix it (or keep it from happening again).  I am in control.  Blaming myself allows me to maintain the illusion that I have control over my environment and that I can prevent bad things from happening to me (and am therefore able to keep myself safe). 

In future posts I will talk about ways to move past self blame...

Sunday, April 21, 2013

The guilt of feeling satisfied

I previously mentioned that I wanted to spend some time thinking about who I want to be - my ideal self.  This isn't the first time I've considered this.  A few years ago I could've readily identified the areas in my life in need of improvement.  Even now there are things I try to be mindful of: to refrain from snapping at people (especially my husband) just because I'm tired or in a bad mood; to spend more time attending to and interacting with my stepdaughter when she's with us; to call two or three close friends on a regular basis (time passes quickly and it's easy to lose touch, even with people you care about); to spend time playing (or at least attempting to play) with my nieces when we're together; and to stop what I'm doing and give my full attention when someone is trying to have a conversation with me.  There are some other things I can't recall at the moment.

So I do make a conscious effort to cultivate particular ways of being.  There are also things I would like to do in theory (such as doing volunteer work in my spare time) but I know myself well enough to recognize I will never muster the motivation to do them.  I am not perfect; my life is not perfect.  For the most part, however, I am happy and content with myself and my life. 

It seems that this is both a blessing and a curse.  I have not always been content in life, so I appreciate what a blessing it is just to wake up most days feeling good.  I do not take this for granted.  On the other hand, I have absolutely no drive or ambition.  I had both of these when I was younger.  I was intensely focused on my educational and career goals.  I successfully achieved these, and within the timeframe I'd set for myself.  I finished my bachelors and masters degrees.  I bought a house in my early twenties.  (Unfortunately, I am now unable to get rid of this house because housing values have fallen so much since the recession).  I like my job; right now, it's exactly what I want to be doing.  I am naturally curious, so I'm constantly learning new techniques and ideas.  Still, I see little need to pursue additional training in any particular technique or strategy. 

I knew when I entered my profession that I'd never be rich.  Currently, I have a good idea of how much others of my profession living in the same geographical area earn and my salary is comprable.  I haven't had a raise in three years, but I suspect that this is due to the nation's economic problems and not specific to my employer.  Do I want to make more money?  Sure.  Do I want to find another job?  Not at all.  Even if I could make a little more money (probably no more than $10,000 a year more than I make now) somewhere else I don't really want to work anywhere else, at least not right now.
I do have one concrete goal right now: for my husband and I to buy a bigger house so we can expand our family.  Starting this month, I'm going to start paying extra towards the principal on my mortgage.  I've also been saving a few hundred dollars each month for the past several years.  (And I think I've saved every tax return I've gotten since I started working).  Hopefully these efforts will eventually help me achieve my goal.  I suppose I could get a second job to accumulate money at a faster rate, but it would make me unhappy.  (I know this from previous experience - I don't have enough free time when I have a second job and it makes me unhappy). 

In summary, I have no interest in pursuing additional education (at least not formally; on an informal basis, I will never stop learning new things).  There are no "promotions" at my current job; my colleagues and I each practice as independent clinicians.  Our supervisor is a military public health officer.  Unless I plan on joining the military (I don't), there is no room for advancement.  Going by past experience, I will probably get a modest raise at some point in the next several years.  I'm okay with this.  I am not actively looking for a better paying job.  The only concrete goal I am working towards (excluding my general aim to be a good person and to spend as much time as possible with the people I love) is buying a bigger house.  For these reasons, I have been told that I lack ambition.

Ambition is "the earnest drive for achievement and the willingness to strive for its attainment."  If this is an accurate definition then I cannot deny it: I have very little ambition.  I possess no drive, earnest or otherwise, to achieve any particular goal.  It is obviously not possible to strive for the attainment of goals that do not exist. 

At this point in my life I am the happiest I have ever been.  Beneath my contentment, however, lies a kernel of guilt.  Lately I wonder if I should be doing more.  Am I selling myself short?  Am I using my talents to the best of my ability?  Do I lack ambition because I am content with life?  Or is it because I've grown lazy? 

Sunday, April 14, 2013

Self Mentoring?

From my first human services class as an undergraduate student, through graduate school, three internships, my first "real" job,  and my experiences as a clinician, my development as a professional has been entwined with my emotional and psychological growth as an individual.  I've often found that my professional experiences have been the impetus for self exploration; many times I needed to first grow and change as a person in order to become a better clinician.  In this way, my personal and professional growth have been and continue to be inseparable.  Would I be as self aware and emotionally healthy if I'd chosen some other line of work?  I doubt it.  Would I be as good of a clinician if I hadn't devoted so much time and energy to dealing with my own psychological and emotional baggage?  Definitely not. 

While my career as a clinician has been integral to my own development, one need not be a psychotherapist in order to achieve personal growth.  This is, in fact, the idea behind the field of self-help.  Anybody can improve as a person, become more self-aware, understand themselves better, relate to others more effectively, or become more "enlightened." 

I recently came across a relatively new (or new to me) method of self-help: self-mentoring.  I'm not particularly interested in debating the merits of various self-help techniques.  When I come across something new I tend to explore it a little.  If I'm especially intrigued I'll do more research.  Otherwise, I'll take from it anything that seems useful and go on about my life.

So, about self-mentoring.  The first major component of self-mentoring is self-discovery.  It requires a realistic and accurate assessment of you true self - both strengths and weaknesses. I can definitely support this, given my strong belief in the merits of self-awareness.  Suggested "self-mentoring" strategies for self-assessment include self-monitoring, self-reflection, seeking feedback from trusted others, consulting professional or expert sources (to include books, journals, videos, an actual psychotherapist, etc.), and/or completing any of an infinite number of personality assessment inventories (which can be quite helpful if you've never done one.  I personally recommend the Myers-Briggs.  If you Google Myers-Briggs personality assessment, you can probably find several free ones online).

A quick aside -- personally, I think it is  impossible for any person to ever completely know himself.  I therefore believe that self-assessment should be an ongoing and lifelong process.  Self-awareness promotes mindfulness and makes it easier to have meaningful relationships with others.

 Knowing yourself (to the degree this is possible) is of course meaningless if you make no attempt to use that knowledge.   This brings us to the second major component of self-mentoring: self-improvement, preferably in the form of concrete behavioral change.  In order to change, you must first have an idea of who you want to be.  (They call this your "ideal self").  

In my brief foray into the world of self-mentoring, it was this idea of an "ideal self" that made the strongest impression.  It's not that I've never heard of this concept before; I have.  It just made me realize that I haven't given much thought recently to who I want to be.  I reflect a lot on who I am and I definitely try to be the best version of myself as often as possible.  But who do I want to become?  I honestly don't know.  And so I suppose I need to give it some thought...

Sunday, April 7, 2013

The comfort of a good routine

My stepdaughter was on Spring Break this past week so I took off from work to spend time with her.  My sister held her annual Easter Egg hunt the day before Easter.  We went to church with my family on Easter Sunday and had lunch with family afterwards.  We took a two day trip to Baltimore with family on Tuesday and Wednesday.

I always have to prepare myself mentally the week or so before a vacation.  It's not that I don't enjoy the time off from work and spending time with people I love - I do.  It's just that it's very hard for me to deviate from my routine.  My weeks are typically quite structured.  I get up at 5 AM, get ready to go, and arrive to work between 7 and 730.  Even what I eat for breakfast rarely changes: oatmeal with brown sugar and fruit. I get off of work at 4 PM.  I go home, change clothes, and head to the gym.  I spend about 45 minutes at the gym (where I do a strength training routine and either jog on the treadmill or use the elliptical), I come home, change into sweats, and relax.  My husband and I eventually sit down for dinner and spend a little time together before I go to bed around 930.  That's my week, at least Monday through Thursday.  On Fridays, I come home and try to clean up around the house.  Sometimes I meet up with friends for dinner.  Saturdays are free days.  Sundays I go to my parents' and have lunch with my family.

I know, my life isn't very exciting.  Some people might say it's quite boring.  Not me.  I like the calm predictability of structure and routine.  It's familiar.  It's comfortable.

Now I realize I'm probably a little too comfortable with my routine; I have a hard time deviating from it.  I hate when someone calls me at work and asks me to accompany them to some spontaneously planned event that same evening.  I'll usually go, depending on the event, but if it requires me to skip the gym then I end up feeling guilty.  I realize that this is slightly unrealistic.  That's why I typically end up attending whatever event I've been invited too, despite feeling a bit guilty.  Just because I feel a particular way doesn't mean I have to act on those emotions.

And then the vacation inevitably comes to an end.  This is where a little mindfulness is helpful.  It's not unusual to start lamenting that vacation is "almost over" several days before it ends.  Every time this thought comes up it brings with it feelings of disappointment.  These feelings keep you from fully enjoying what's happening now, while you're still on vacation.  I've done pretty well at avoiding this trap.  What I have a more difficult time with is the disappointment that comes when vacation is officially over.  I find myself reliving everything I did and wondering if I made the most of it.  Having looked forward to this vacation for weeks, I find myself thinking about what I have to look forward to now.  Why is there this need to have something to anticipate?  Why not be satisfied with the vacation I've had and get back to my normal routine? I realize this is a common habit; perhaps it's human nature...

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