Tag Archives: timing and dosage

On Vulnerable Communication: Timing and Dosage

From the couples and family therapy files at Embolden Psychology

The amygdala (my nickname for this area of the brain is Amy) is the part of the brain that is activated during feelings of fear, anxiety, threat, and aggression. By putting feelings into words — a process known as “affect labeling” – we can help diminish Amy’s response when we encounter things that are distressing. Verbal expression is generally controlled by the left hemisphere of the brain, including the temporal and parietal lobes. In addition, the frontal lobe helps with decision-making and problem-solving. It also tells you what not to say: impulse control. This ‘party of four’ – Amy, as well as the parietal, temporal, and frontal lobes, are all part of the ability and vulnerability to share personal problems with others.

Underneath it all is an actual desire and commitment that you want to communicate without harm to self or your loved one(s). Related, read Healing in Relationships: Imago Therapy for Communication. 

The ability to express feelings to a trusted other entails employing relational / interpersonal / social skills, verbal skills, and the most mundane and important strategy of all: practice. While some people may have seemingly kissed the Blarney Stone, for most, communication requires effort and practice.

Important factors include timing and dosage. When you get a medication prescription, it tells you when to take (or give) it and how much to ingest. Vulnerable communication is much the same.

*Physical state. If you are not a ‘night person’, and you’re exhausted, that’s probably not the best time to engage in a conversation. Similarly, many people cannot converse or listen well early in the morning.

*Mental state. If you are someone who can become angry or impulsive at times of duress or stress,walking away can be very helpful before speaking.  Most people do not speak very well when Amy is the major person in the room.

*Location location location. No one can listen well if they feel cornered. I always suggest to parents not to confront children or teens in their bedroom or in the car. Some of my adolescent clients have told me they felt like jumping out of the car because they had nowhere to go and their parent was ‘talking at them’.

This is equally true for adults. Some couples may continue an argument for hours, even physically following each other while one person tries to ‘get away’. Some believe that you have to talk it all out as soon as possible, but if your partner does not have the propensity or ability to do the same, it can actually create harm. Taking a time out, no matter your age, when feeling stirred up, is a good idea. Set a time to talk later. That doesn’t mean that you are sweeping things under the rug. It means that you are acknowledging the respect of speaking at a time where everybody is in a better headspace.

*Emotional learning skills / EQ. Not everyone knows how to verbally express their emotions. This is an important point for compassion for self and others, as well as a commitment to learning how to communicate. If you had no role models to show you how to discuss emotional experience and feelings, how are you supposed to know? The good news is that it can be learned and practiced like all other learning.  Related, read: What is Affect Phobia?

*Ask for consent. Reciprocal communication requires permission. Is this a good time to talk? May I set up a time to discuss something?

*Pick your people. Have a trusted friend who will support you. If you need a lot of talk time, try spreading your conversations out to multiple people. One person can get worn out, and having a broad social support system lets you distribute that load. In a healthy relationship, I always say that things are 49–51. There is no 50/50. But no one should have to carry the bulk of the emotional labor habitually.

*Talk with an end point. Absolutely no one I have met can talk for hours, especially with intensity. When you have a discussion that’s going to be affect-laden, limit it to a pre-agreed-upon time and duration. I have couples practice this in my office with actually having a physical object, such as a small ball or baton to pass back-and-forth. Listening to intently is not a skill that most people have without practice. In fact, research indicates that most people know what you’re going to say before the other person is even finished talking.

*Do not co-ruminate.  Contrary to the old adage, misery does NOT love company. Having a group of friends who are consistently negative, coworker who complain regularly, or online chats that are focused on how terrible your child/partner/spouse is have shown no significant effects on the ability to share vulnerable feelings, reduce distress, or experience relief.

*Writing helps. A number of studies from the department of psychology at Southern Methodist University have shown that writing out your feelings can be as effective as expressing them verbally. You don’t even have to share what you write. But being able to ‘get out of your head’ from what you’re experiencing, perhaps even a repetitive or intrusive thoughts, is helpful. Writing also creates a sense of continuity in thought. See also Restorative Writing on Mental Health.

*Seek professional help. Being able to have a place to vent where you feel safe and not judged is the essence of therapy. I always say to my clients, I may see you for three hours a month. In between, there’s a lot of living that happens. If possible, write it down.  Those three or four hours each month can give you a space to present and process those feelings, and not have them used against you. In a journal or your phone Notes App, jot down your thoughts, if you’re not sure that you will remember what you want to say in the therapy session.

*Practice a range of verbal expression. Talk to people you care about regarding both positive and negative feelings and experiences. Speaking about the positive as well as the negative is like a bank account. You won’t go into emotional overdraft if you do both. Interestingly, the simple act of texting during the day, even a check-in, has shown interpersonal positive effects. Read: https://embolden.world/the-power-of-texting/

*Not everyone benefits from talking it out. This might seem contradictory to the ‘traditional’ verbal expression model of psychotherapy. In their clinical psychology research, Drs. Siddique and Bonanno found that dispositional repression was at times related to good mental health. This was even true of individuals who had suffered early conjugal bereavement and other traumas. This sub-group appeared to receive more social support, and returned to their regular routine faster than people who expressed feelings of bereavement and loss. Individual differences matter when it comes to self expression.

Not everyone benefits from endless analysis of feelings, a hard truth in clinical psychology.
From the American Psychological Association online library: https://psycnet.apa.org/record/1999-02328-010
On emotional dissociation and self deception: at play in the fields of consciousness. Bonanno, G. and Siddique, H., Lawrence Erlbaum, New York, NY, 1999.

The PainShare: On helping friends and family with chronic pain conditions

Having a loved one who lives with chronic pain can be challenging. Often we yearn to somehow lessen the burden and on the bad days when they are in excruciating distress, the helplessness can overwhelm us.  At times, this can lead to avoidance, we don’t know what to do so we don’t. Sometimes we can create more anxiety for ourselves and them by expressing excessive worry.

Timing and Dosage
When a friend or family member develops or is living with a chronic pain condition, we all struggle with how to be and how not to be. We all want to be compassionate and supportive; to be helpful without being intrusive; to not minimize and not smother; to try to understand; to cheer them up whenever we can.

While dealing with a friend’s illness is never easy, chronic pain conditions are especially difficult because the pain can vary in intensity from day to day, symptoms wax and wane and sufferers often don’t reveal the pain. Sometimes, chronic pain isn’t visible. The variability can be one of the most difficult factors. One day, your loved one might be optimistic and energetic. A few days later, they may not be able to move out of bed to shower. Often there may be a host of physical symptoms that your loved one might find difficult to even describe because they can range from embarrassing to wordless.

People are not their illness.
When a friend is suffering, whatever the cause, they don’t suddenly turn into another person. Friendship is friendship. Now and then, one or both of you many offend, anger, or disappoint the other. Mistakes will be made on both sides. That happens between close friends even when illness isn’t a factor. When these missteps and misunderstandings happen, acknowledge the situation and have a calm conversation with your friend about what happened and why and how to avoid the quarrel in the future. Then apologize to each other and move on.

Don’t assume. Ask.
Chronic pain isolates sufferers both physically and psychologically making it difficult for those with pain to interact with the world and their friends. Ask in a straightforward way what somebody needs and how they are.  Let them tell it without having to fix it. If they tell you they had a crap day, that’s what happened.

Don’t play Mother Teresa.
All humans need to feel useful. You’re not there for charity or pity, you’re spending time with somebody you love. They want to have a reciprocal relationship. A close friend who has bouts of unrelenting pain regularly checks on me, makes me gifts, helps me with my work and writing, and spends quality time with me whenever she can.

Become comfortable with uncertainty
One client wrote me: “It was great to have a session in your office today;I can’t predict what my body will dictate on September 1.” A friend told me she no longer makes any plans that require a reservation because she’s not sure if she’s going to be well enough to go. As a friend, be comfortable with changing circumstances. So when you invite someone with CP to join you for a movie, book club, walk, or dinner, assure them that the invitation is non-binding and that if they have to cancel—even at the last minute—you will understand. An invitation without obligation is one that a person with CP may feel more comfortable accepting. At the same time, invite them. Excluding people without asking because you think they’re too fragile is not helpful.

Let them set the schedule.
People with chronic pain have learned how their body works through trial and error. For the most part, they know when they have peaks of energy. They know when they need to do their work, their chores, work on the computer, or go for a walk. They also know when they need to rest and when they want to spend time with you. If you are lucky enough to have a body that doesn’t periodically betray you, go with what they need physically.

Don’t idealize (their) pain.
Sure, you might think they are a superhero or warrior. And they probably are. Admiring people for suffering well, which we do as a society, does not allow them the space for the vulnerability they need to feel self compassionate or ask for help.

Don’t take it personally.
When a person is ill, as a social being, we want to visit, to cheer them up, amuse them, chat, feed them, or just keep them company. But for people with CP, the unpredictability of their pain makes it difficult to plan and engage with visitors. They may decline your offer to visit. They may cancel. They may say they are not available after a certain time of day.  And while it may seem that your friend doesn’t want to see you, the reality is different. They are not rejecting you, they are caring for you and their needs simultaneously.

Don’t be the armchair expert.
It’s likely that your loved one with chronic pain has done extensive research on their own on medication, treatments, and alternatives. If they need specific help with a research area, they will ask you.

Enjoy the beauty of the ordinary
Sharing books, shows and movies, good conversation or chats, laughter, recipes, daily routines, can be very comforting and uplifting. This is especially true when somebody is going through a period of multiple medical appointments, medication changes, frustration with insurance companies, and a new flareup or bout of symptoms.

What to do : be practical, consistent, and warm. 
– I’m making soup/curry/roast chicken tomorrow. Can I bring you some?
– If you drop off items for someone, ask them if you should leave them outside their door, they may not want to see you but they will still appreciate your care.
– I’m going food shopping tomorrow. How about I pick you up some salad fixings, fresh fruit, milk, coffee, tea, cereal, and any other staples you need?
– I’m taking my kids to the park tomorrow. I’d love to take your kids along to keep mine company.
– I’m running a bunch of errands this afternoon. I can easily check some items off your to do list while I’m at it. Do you need anything mailed, picked up or dropped off at the cleaners?
– I’m in the mood for some canine company. Can I walk your dog?
– I’ll be happy to take the trash out for you (or put away groceries, change cat litter, clean out the refrigerator).
– If they are self-employed and have been unable to work, the financial hardship can provide another layer of trauma and difficulty. Offer to pay a bill or buy groceries.

What not to do/say:
– Make comparisons. (‘I remember the time when I had the flu for two weeks. It was awful having to be in bed’).
– Say: you look great. It’s hard to believe you’re even in pain.
– Say: (Higher Being) only gives us as much as we can handle.
– Suggest that they need to exercise, eat better, take vitamins, sleep more, do yoga, and they will get better.
– Say: it’s in your head, think positive.
– Avoid them because you don’t know what to do.

Embolden Psychology

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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