Tuesday, December 16, 2014

Holiday Gift to yourself: Forgiveness

Seasons Greetings!  I know that we all manage to do things that we regret in life.  Some of us come to terms with that and move on, but a lot of us get stuck.  I hope this season, you can get caught up in the practice of giving gifts and do yourself a big favor and explore the awesome power of forgiveness.  Maybe someone needs it from you.  Maybe you need it from someone.  Perhaps that someone is you!  Enjoy the following paraphrase of a therapy session in three parts.  Leave comments if you found it helpful.  Share it with friends!  Happy Holidays!

Forgiveness, pt 1.
Client: I used to pray every day, asking for forgiveness.  I mean, who does that?  Who walks away from their child? 
Me: Whose forgiveness were you seeking?
Client: I don’t know.  God’s?  I hope my daughter can forgive me.
Me: Is it okay if we explore those for a moment?
Client: I guess.
Me: Well, let’s play a game of “what if…”  Suppose that your daughter actually came to you and said, “Mom, I forgive you.  Truly, you have my forgiveness.” Do you suppose you would accept her forgiveness or would you still feel guilty?”
Client: I would probably still feel a little guilty.
Me: I see.  So whose forgiveness do you need to accept so that you no longer bear the burden of guilt?
Client: God’s?
Me: Okay.  Yeah, that is a very important aspect.  God’s forgiveness.  So, to continue the “what if…” game… What if God came to you and said, “Hey, good to see you!  Here, I got you this gift!”  I mean, it is the holidays and all right? So, God tells you that he got you this gift.  How would you receive it from him?  Would you accept it?  “Wow, thanks so much God… but I didn’t get you anything.”  He would be all, “That is okay, there is no way you could match this gift, it is just something I wanted to give you.”  And a lot of the time we say in return, “No, I can’t accept it.   It is too much.”  And God says, “No, really, this is important.  It is a gift.  Take it.” and we still fight with him, “But I don’t deserve a gift from you…”  Now God is starting to get exasperated, “C’mon!  That is the whole point of a gift… you didn’t earn it… you couldn’t earn it.  Of course you don’t deserve it.  Nonetheless, it is my gift to you.”  So you finally open it and it is the gift of forgiveness.  You say, “God, I really don’t deserve this.”  He replies, “I know.  But my willingness to give it to you is not dependent on you being deserving of it.  You just have to accept it.  Actually, truth be told, I thought I took care of this forgiveness business a long time ago.  Every time I offered it to you, you sent it back to me, unopened.  Really, the part where I *offer* forgiveness was accomplished a few thousand years ago on the cross of Calvary.  What we are dealing with now is your acceptance.”
Client: So, God has already offered me forgiveness even though I don’t deserve it?
Me: Yes.  I believe God still wants us to make changes in our lives and live differently, live better… that is on us, but as far as offering us his forgiveness, that part has been done.  So, let me ask again, whose forgiveness do you feel you need so you don’t feel guilty anymore?
Client:….  (in a small voice)  I don’t know.
Me: Whether or not your daughter forgives you, you shared that you would probably still feel guilty.  God is willing to forgive you, he has made that clear…. Who else do you need forgiveness from?  Who is reminding you daily of your guilt?  Who is still blaming you?
Client: ….. (even smaller voice) I guess I am.
Me: So… what if… you were able to offer yourself forgiveness and accept it from yourself?  How would that change things?

Forgiveness pt 2
Client: I know what you are saying about forgiving myself.  How do I do that? I mean, I still feel like because of what I did, I can’t be forgiven.  It is not like I can go back and change things. 
Me: You said that you feel like you can’t be forgiven… but we established that your daughter could forgive you and God does forgive you… What if it was as simple as that example of the gift… you just have to simply say, “Thank you” and accept it like you would a Christmas gift, or a birthday gift. 
Client: I don’t think I can do that.
Me: You would find it too difficult?
Client: No, it is just that I would know what I did.  I can’t go back and fix it.
Me: Yeah, that is rough.  We can’t un-do what has been done.  I get that.
Client: So what do I do?
Me: I wonder if you give yourself any credit for the here and now.
Client: What?
Me: I mean, I think of all the things we have worked on that are clear evidence that you are making different choices and having better outcomes.  You are more responsible for your actions, more accountable for your feelings.  By your own report, you are different now that you were then.
Client: I guess I am.
Me: I remember when I was in college, I had to take a language class where I learned that different words carry different tenses.  For instance, in grammar, there is past tense, future progressive, simple present tense… how we use words carries a sense of timing.  Blame and guilt… those are things that belong to the past.  I cannot logically blame someone for something they haven’t yet done.  “I’m so mad at you for what you will do next week!”  It just sounds silly.  Guilt is concerned with something that was done.  In one sense, guilt is something that is black and white… did you do it?  Did you not do it?  Are you guilty?  In that sense, it is easy to use the word guilt in a productive way.  But the way we tend to use it is in a continuous sense… I continue to be guilty of …. Whatever I did.  But the truth is that when we stop doing…. Whatever we did and we in fact are doing differently now… we sometimes inappropriately carry a continued burden of guilt when it is not helpful. 
Client: So I can be guilty of having abandoned my daughter, but not still be feeling guilty?  I don’t get it.
Me: I think we are conditioned by our society to not understand how guilt and forgiveness work.  Guilt should be the feeling that we need to change something.  If we continue to blame ourselves for stuff we did in the past, we would get stuck and never move forward.  Blame and guilt are not useful for finding solutions and making progress.  They are only useful for accusation and getting stuck.
Client: I sure have been stuck on this for a long time…
Me: Getting stuck is easy.  Getting unstuck takes courage to change how we think and act. 

 Forgiveness pt. 3

Me: I hope you don’t mind me continuing the “what if…” game…
Client: No, go ahead.
Me: This may sound kind of silly, but imagine that you leave this office and go home.  It is kind of late, so you may eat dinner or maybe not.  You probably have stuff to do before bedtime and then you have a bedtime routine, right?  Maybe you brush your teeth, read a book for a while.  Get a glass of water or maybe not.  At some point, you are ready for sleep.  You lay down, take a few deep breaths and then you are out.  Now, while you are sleeping, let’s pretend that a miracle happens.  Something magical… what we have been talking about… the gift of forgiving yourself… it happens.  Overnight.  While you are sleeping.  Now, when you wake up, you don’t know that the miracle has happened, because you were asleep.  But you can tell that things are different this morning.  What might you notice about yourself as you go about your morning?
Client: I would be happier.  I would wake up feeling happy.  I might smile instead of grumping around.
Me: You would feel happier.  That is great.  What else?
Client: Maybe I would have more peace.  Maybe I wouldn’t be worried so much about stuff.
Me: Happiness and peace.  That sounds nice.  What else?
Client: I don’t know.
Me: What would your family notice about you, if this miracle happened?
Client: They would see me smile more.  I would not be so stressed out and they would feel better about talking to me.
Me: They would notice those things about you and respond differently?
Client: Maybe. 
Me: Would your co-workers and friends be able to tell the change?
Client: I’m sure they would.  I would have more patience with customers and with co-workers.
Me: Sounds like it would be nice, this miracle.
Client: Yeah.
Me: What do you think is keeping this miracle from happening?  Is there anything that would stop you from acting as if that miracle took place?
Client: I don’t know.  I guess not.  Just me doing it.
Me: Listen, it is Christmas time.  I’d like for you to go home and get a small box and give yourself a gift this season.  You can put something in the box to represent the gift, or you can leave it empty.  But wrap it up and label it for you and drive your family nuts wondering what is in that small package addressed to you.  What is that gift going to be?
Client: Forgiving myself.
Me: Yeah.  What an awesome thing to do for yourself, and for your family.  Let me know how it works out for you.
Client: Thanks.


Tuesday, August 12, 2014

I hate Anger Management

     One of my biggest gripes as a therapist is that 'Anger Management' is a widely accepted term to refer to a course of treatment that should more accurately be termed, 'Emotional regulation skills'.  It bothers me that Anger gets a bad rap, as far as emotions go.  In my experience, emotions are neither good nor bad, they just are.  They can be uncomfortable, in the sense that we do not enjoy the experience of feeling that emotion (sadness, depression, humiliation, fear) or they can be comfortable (peace, tranquility, happiness, joy).  I try to help people understand that depending on the context, ANY emotion can either be helpful or unhelpful in that moment.
     Most of the 'Anger Management' courses I have come across do a great job at helping people manage the symptoms of uncomfortable feelings like anger.  They teach you to relax, calm down, take a break, scale your feelings from 1-10, etc.  The really good courses also go beyond managing symptoms and help build skills to manage the emotions themselves. 
     Here is one of the first steps that I try to take with clients who are struggling with managing their emotions:

Step 1: Change how you talk about your emotions. 
     I hear people say all the time: "You make me so... (insert emotional word here)"  It is such a commonly heard phrase, no one stops to question the implications.  If it is true that another person can MAKE us feel a certain way, that is very scary.  That means that another person has tremendous power over me.  On the other hand, it also frees me of the responsibility for my own emotions.  In a way, when I use language like that, it frees me from being responsible.  For instance, if "YOU" are making me angry, then I can't possibly NOT be angry until YOU stop making me that way.  See? 
    It is more accurate to understand that others can contribute to how we feel, they can do annoying things or have hateful actions toward us, but our feelings.... how we choose to feel in response to their behaviors... those are our individual responsibility to deal with. 

   So when it comes to changing our language, "You make me so angry!" becomes "I am feeling angry right now."  That is it.  Simply own the feeling. 
"You are getting on my last nerve!" becomes, "I am feeling irritable."
"You always make me feel like a loser!" becomes, "I feel like I'm worthless"
"You make me so happy!" becomes, "I feel happy when I am with you."

An interesting shift happens when we start using our words to accurately reflect what is happening.  Whereas the former statements all contain an element of blame, the latter statements are blame-free.  Can you hear the blame that comes with "You make me sooooo ANGRY?"  It is an accusation about something YOU are doing to ME.  Naturally, when someone accuses me of something, I look to defend myself.  When I get into defense mode, I will eventually realize that the best defense is a good offense and I'll attack (accuse) you back... and suddenly we are stuck in a blame cycle.

When we can own our emotions and stop accusing others of MAKING us feel a certain thing, then we reduce the likelihood that they will need to go into defense mode, and our communication starts to improve.

Try it out and let me know how it works for you.  Take the simple step and change how you talk about your emotions.  No one can "MAKE" you feel anything.  Our feelings belong to us and are our own responsibility.


Monday, March 3, 2014

Vacationing with Diabetes

Having just returned from vacation, I would normally be sharing the highlights of the trip.  But I'll save that for other social media.  Here on the blog, I want to discuss the experience of taking Diabetes along with us on vacation.

You see, Diabetes doesn't just visit us occasionally, he barged into our lives 10 years ago and will not go away.  Our vacation prep started by trying to pack and tie up loose ends, but also included shelling out big bucks to make sure we had supplies to manage the kids' diabetes while on the road: extra insulin pods, extra insulin, syringes, test strips, glucagon shots, ketone strips, juice boxes and skittles and PB crackers for lows... 

Once all that was taken care of, we loaded up and started on our trip.  On the second day of the trip, we hit our first bump in the road: apparently, of all the extra insulin pods (Omnipods, the brand of pump we use), we apparently had over half of them from a bad lot which kept failing.  We usually change pods every three days.  Planning on being gone 9 days, that means, at minimum we needed 3 pods per kid, or 6 pods.  We packed 15.  By day two, we had already run through four pods because they kept failing, requiring us to discard the malfunctioning pods and apply new ones.

Traveling means long stretches of inactivity while riding in the car, coupled with boredom and a lack of healthy snack foods means we typically have higher BGs when on the road.  That is not usually a big deal, as we compensate for it with insulin intake and extra BG checks.  However, on this trip, we were fighting blood glucose lows instead of highs.  We went through lots of juice boxes and snacks and had to be extra vigilant for the first leg of our trip.

Our Service Dog, Sherly, at the Grand Canyon
Sherly watches over the kids as they explore the Grand Canyon
After our first long day of travel, we spent day two at the Grand Canyon.  It was breathtaking.  It was amazing.  It was a place where memories were made.  Of course, diabetes wanted to make some memories, too.  After being cooped up in the car, the previous day, diabetes came with us as we hiked along the South Rim.  I wish we could have just enjoyed the view, but we had to stop every couple of hours and make sure the kids' BG were in range.  All in all, it wasn't such a bad BG day though.

Day three at the Hoover Dam was a blast, but keeping up with supplies and keeping the kids' kits stocked was a challenge, because we were burning through juice boxes.  Turns out, while Amelia, MH and I were touring the visitor's center, we got a call from our traveling companions that Ethan had left his glucometer in the car, which was parked in the parking structure.  Not an insurmountable challenge, but it highlights one of our challenges.  If he had left his wallet or his camera, we would have said something like, "Oh, well.  You need to learn to keep up with your things, mister."  But we cannot NOT go get his glucometer/controller for his pump.  I want to point out that 90% of the time, both kids are very responsible with keeping up with their kits, but those 10% when they forget, it is almost always inconvenient.
We drove from Hoover Dam to Las Vegas to have dinner on the strip and got to see some amazing things, like the fountain in front of the Bellagio and costumed vendors hawking photo opportunities for "tips" (I'm sorry, but the standard tip is $5, sir...)  On our hike up and down the Strip, MH had a low and we discovered that neither of them had restocked their kits with extra juice or crackers, but we managed (this will be a theme for the rest of the trip).

The next morning, we got up and made ready to travel to the end of route 66: The Santa Monica pier!  But before we left, we needed to change MH's pod and... you guessed it...old pod off and two pod failures from the bad lot means three more pods unusable.  We are now three days in and we've gone through half our pods.  The rest of the drive to the coast was scenic as outside we saw the environment change from desert to mountain to coastal plains.  We spent the rest of the day playing in the Pacific and on the pier.  It was fantastic. 

One of the side effects of traveling, we discovered, was the stress it adds to an already stressed out Diabetic Alert Dog.  Aside from having her routine interrupted and rollercoaster BGs with the kids, she didn't eat very well and developed an upset stomach.  Sherly started exhibiting signs of distress and we ended up having to take her to the vet the morning we were supposed to head to Disneyland.  We ended up letting her stay at the vet the first day, but it put us a couple of hours late.  Then, after only one ride, we stopped to check BG and Ethan's pod failed.  And then the spare he brought with him failed.  And MH didn't restock her kit from the day before so we had ZERO pods and ZERO extra supplies.  So, Ethan and I left the park and went back to the house where we were staying to gear up and restock.  That put us back to Disneyland at about 2pm, having only experienced the parking facility and Cars Land (in California Adventures).  The rest of the day went by without a significant incident until, at the end of the day, when we were watching the Wonderful World of Color, Ethan started crying.  I asked him if everything was okay and he made some nonsense reply and I immediately sat him down to check his BG: he was low.  Luckily, we had supplies, so we quickly recovered and enjoyed the rest of the show.  

I won't bore you with the minute by minute details of how diabetes follows us around and makes us jump through hoops, but the following pictures are typical of every couple of hours (or sooner), we would have to stop what we were doing and make sure that the kids weren't about to get sick from high BG or pass out from low BG. 

After all the pod failures, we panicked a little and had the Endocrinology team at OU call in some Lantus and backup supplies to a Wal-Green's in Anaheim.  We figured that at the rate we were going through pods and supplies, we had better have backup in case we ran out and had to revert to using Lantus and Novalog injections.  Unfortunately, with it being the beginning of the year and our deductible not met yet, that set us back another $1,000.  OUCH!

I guess the only other big event that happened was our 2nd day at Disney, we had extra supplies in Amelia's backpack and had even had Ethan repack his kit so we could use the backpack for extra supplies.  At one point, Amelia and the girls all went for a special lunch with the Princesses and I was with Ethan and his best friend, Jonah Mace, and their family.  Ethan said he felt low and checked his BG and he was 53.  I told him to go ahead and drink a juice and we would get some lunch.  At that point, we had this exchange:
Me: Okay, get a juice and some crackers in you, brother.
Ethan: Um, dad, you told me to clean out my backpack so mom could use it for supplies.
Me: Yes.
Ethan: So I did, but all of my supplies were in the backpack that mom has.
Me: You didn't restock the kit you have with you?
Ethan: No, I just have my glucometer...
Me: *sigh*

We powerwalked through the crowds, trying to get to a place to buy him a juice and some carbs.  Everywhere I looked, there were long lines for the food vendors (it was lunchtime, remember) and I was worried that he was dropping and would pass out.  Luckily, I was able to get into a store and buy a pretzel and some Apple juice (and two juice boxes for spares) and bring up his BG pretty fast.  I couldn't help thinking that if circumstances were just a little different, I might have had to call emergency services.

MH had one instance where she felt so shaky that she sat down in a store at Disney to check her BG and one of the staff told her she couldn't sit in the middle of the aisle.  MH was so low it was all she could do to scoot over to one side and continue to treat herself with fast sugars, but it upset her.  Amelia spoke to the supervisor and educated them about how to approach someone who was in the midst of checking BG.  She said, "The supervisor had a reasonable expectation that people should not just sit in the middle of the aisle, but when someone obviously has medical equipment out and is checking their blood sugar, a more appropriate response is to ask if she is okay, not to chastise her for sitting down.  I pointed out that it would have been worse if she had passed out while standing up and hit her head on one of the kiosks and bled all over their floor.  The supervisor got my point and apologized."

The return trip home was fine, with no diabetes issues.  But to recap: our vacation was fantastic, but the diabetes part was a drag.  Rollercoaster BG due to diet and exercise changes on the trip, pump failures and supply costs, vet expenses for our poor stressed puppy and trying to manage responsibilities with the kids restocking their kits...

I walk a line of being thankful that our diabetes is manageable (usually) and being resentful of having to manage it at great expense of our time, energy, health and finances.

Diabetes, I hope you enjoyed your time on our vacation.  I wish we could take a vacation from you.