Too often, we therapists neglect our personal relationships. Our work becomes our life. At the end of our workday, having given so much of ourselves, we feel drained of the desire for more relationship. ID Yalom, 2002 (The Gift of Therapy).

Do you ever feel like you have given so much of yourself to your work – to building relationships with patients and clients; to going the extra mile to provide care and compassion; to doing so again and again, throughout your working day – that you have nothing left when you get home? And then you feel guilty that your children aren’t getting the best of you.

Or do you feel so protective of precious family time, making extra effort to be present and engaged at home, that work just feels like you have to be on autopilot, going through the motions, protecting yourself from being too emotionally engaged, because of what it might cost you in emotional resources?

Compassion and caring aren’t finite resources, but we do need fuel in our emotional tanks to be able to maintain our compassion over time, in the face of challenges, and to avoiding burning out. This is true of both being a parent, and being in a healthcare or helping role, and doubly so when you are both.

We are all doing the best we can with the resources we have available to us. When we are burning out, reaching our limits, not being our best parenting self, or our most compassionate professional self, it isn’t a problem of knowledge, skill or understanding, but one of capacity. Self care is key to topping up our emotional fuel tanks and to creating capacity to continue to care for others.

What is self care?

Self care encompasses many things. From meeting your basic needs such as eating and drinking, to meeting other needs like the need for connection, autonomy and recognition. I use it to describe any of the practices that nurture yourself and add fuel to your emotional tank.

Self care can include long baths with candles and going to get a massage, but in this blog I’m going to focus on three types of self care that in many ways could not be further removed from this: I’m going to talk about “micro self care”, caring for yourself when you are not by yourself, and self care as an attitude.

The limits of self care

But before we get to looking more at this, an important caveat. Firstly, self care is not really self care if it is yet another thing on your TO DO list, one more thing for you beat yourself up over, or for anyone else in your life to beat you round the head with either. Too often, for both parents and for healthcare workers, it can be used in this way.

It’s too common to be made to feel that if we are stressed it is our own fault for not practicing “good enough” self care. Self care is not about managing intolerable levels of stress indefinitely. So self care isn’t a cure-all for toxic working cultures or a challenging home life. But here’s how it can help.

Micro self care

We all operate at our best when we are inside our “window of tolerance”. The idea is that when we are feeling calm and connected, we can draw on skills like empathy, problem-solving and emotional regulation. When stress builds and we move outside our window of tolerance we are in our fight/flight or freeze state. We are less likely to be able to draw on our rational thinking skills because the emotional centre of our brain has taken over to try to protect us from the perceived threat.

I know that shouting at my toddler doesn’t help either of us, but when I do so, it’s because I’ve been skirting too close to the edge of my window of tolerance for too long, and I simply don’t have the resources in that moment to respond helpfully.

It isn’t always one massive thing that sends us into our threat response. Sometimes it is the accumulation of lots of smaller things, manageable on their own: trigger stacks on trigger, straw upon straw, until the camel’s back is broken. But, just as an accumulation of small things can push us out of our window of tolerance, so too can small things brings us back, by removing one straw at a time.

So self-care doesn’t have to be all or nothing. You don’t have to wait until you have time for a massage or a holiday to do things that help your stress levels. By peppering self care throughout your day, you can prevent stress from building up.

For example, in “Simple Self Care for Therapists” Ashley Davis Bush lists hundreds of small acts of “micro” self care, things that fit into the time between appointments, that can be done in different places, to ground us, energise us or relax us.

You could try a grounding practice while the kettle boils, drink your cup of tea mindfully, or do a three minute breathing space exercise at your desk.

There are self care practices you can do if you have one minute (feel your feet on the floor, notice 5 things around you that are coloured green), five minutes (get a drink, do a three minute breathing space), or a bigger chunk of time like 20 minutes (a power nap, watch something funny, do a guided mindfulness meditation).

Try to make self care a habit by linking it to the patterns and activities of your day.

Caring for yourself when you are not by yourself

The Australian Clinical Psychologist Amanda Donnet (Spilt Milk Psychology) describes parenting as like “learning to breathe underwater”. Becoming a parent can feel like inhabiting a new underwater world, where things look and feel different. Many parents feel like they need to make a break for the surface, to be their old selves again, in order to take deep lungfuls of air and reset themselves.

But if our only coping strategy is going back to not being a parent for a while, then it makes going back under the water feel difficult. Instead, Donnet argues, we need to learn how to breathe and be comfortable under the water and to do this we can ask ourselves, “how can I do things for myself when I’m not by myself?”

Lots of the micro self care practices discussed above work here. Even better if what you do benefits or entertains your child too. That might be directly involving them in the self care – for example doing yoga or mindfulness together. Or it might be about picking activities where both your needs get met.

Lucy Aitken Read talks about Sites of Mutual Fulfilment, which are places “where both the child’s and the parent’s urges and needs are met. They are places where all parties leave with a full cup. They are the vital mental health break in a day for mum or dad.”

Try to find the places both you and your child find restorative. It might be that you love a particular park because you feel connected to nature, and your child likes the open space to have more freedom to run around while still being safely seen. Play games with your children that allow you to be still and sitting (if that’s what you need in the moment) while they run around and burn off energy – for example, time them on an obstacle course round the lounge, or send them off on a scavenger hunt round the garden or house.

Self care as an attitude

Self care isn’t always about things we do, it can also be about how we speak to ourselves, how we notice our own needs, have compassion for our own suffering and engage with ourselves with kindness rather than criticism. As a parent, and as a healthcare professional, we become adept at noticing others’ cues and responding to them, soothing them when they are upset, seeing the best in them, having compassion and empathy for their feelings and challenges. Imagine if we could cultivate the love we have for our children, and the kindness we have for our patients, for ourselves?

Try as an experiment talking kindly to yourself, in the way you would (in your calmest moments) talk to your child. What would you say to them if they were feeling this way? You might even let them hear you say it to yourself: “You are so tired, you’re trying your very best all the time, it is exhausting, no wonder you sometimes need help.” Children learn their own self talk from how we talk to ourselves, as well as from how we talk to them.

Having an attitude of self care could be about checking in more regularly with what you need, and setting appropriate boundaries that help you to meet those needs. It could be about asking for and accepting help (and being able to delegate the whole of the task, including the preparation and the mental load).

Sometimes it might be about lowering the bar and allowing yourself to be imperfect. And on tough days, really lower the bar. No harm will come to your children from eating ready meals and extra screen time on the days where that is all your resources will allow.

With these three tips it’s my hope that we can all find regular, nurturing, effective self care. Self care doesn’t have to take a lot of uninterrupted time. Why not experiment, and see what works for you? By using the small moments in our day, adjusting unreasonable expectations of ourselves, treating ourselves with kindness, and learning how to balance our needs with those of our children, self care can be within our reach after all.

Dr Hannah Guzinska is a Clinical Psychologist with a special interest in babies and very young children and their parents. She offers consultations around parenting young children and CalmFamily (Baby and ToddlerCalm) Workshops and classes, and works with organisations which support families in the early years. She has made a video on self care for new parents which was runner up in the IJBPE First 1000 Days competition: and has a blog and mailing list.

The post 3 top self care tips for parents who are also health professionals appeared first on Dr Paula Redmond, Clinical Psychologist.

Defeated > miserable >  lonely > fat

That’s the loop my brain does whenever I start to feel overwhelmed or exhausted. When I’m tired or have too much on my plate I very quickly start to feel like a failure, usually because I can’t live up to my own impossible standards.  I then start to feel as if everything is rubbish, and like I can’t enjoy anything, or that there’s nothing to look forward to.  My mind then swiftly turns to thoughts that no-one likes me (who would when I’m so rubbish and boring?), and inevitably that I’m too fat.  And of course that makes me feel even more defeated, and so it goes on.

It’s pretty impressive that our minds can do this.  They can extrapolate something simple like a broken night’s sleep into a primal fear of alienation and rejection. This ability to imagine the minds of others, to project into the future, and reflect on the past, is what makes us human. It enables us to invent, create and achieve incredible feats of courage and compassion. But it is also what creates ongoing stress and misery.

Our ancient tricky brains

Psychologists (particularly those working in a compassion-focussed way) often call this our “tricky brain”. We still hold onto our reptilian roots and are primed to respond to threat through flight, fright or freeze responses. But our tricky brains have the amazing power to conjure up all sorts of threats.  For many of us, most of the time, these are not life threatening. At their core they are usually related to fears of social rejection – in our past being kicked out of the tribe would have meant we would be unlikely to survive.  Today common threats are failure, letting others down, not living up to expectations, upsetting others etc.

The stress response

Unfortunately, our tricky brains can’t distinguish between a life-threatening situation and one that is socially threatening, and so our bodies respond the same way. When our brain detects threat it triggers the body’s natural survival responses – our bodies are primed to fight our way out, to escape or to freeze until the threat has passed.

And this isn’t always helpful.  It doesn’t really help us in job interviews to feel tense and sick and have our heart racing. But if we had to flee a pack of wolves this physiological response would be super helpful as our muscles would be primed for action, our bowels might empty themselves so we’d be lighter on our feet, and the adrenalin surge would energise us to do what we needed to survive.  This leads us to a key message: this response is not your fault.

Key message 1: The way your body responds to stress is not your fault

This stress response is not our fault. It’s a natural by-product of a very important and clever evolutionary mechanism.  We don’t choose to respond in this way, we just do. Thanks to our tricky brains.

Another downside of our tricky brains is about what happens once the stressor is  no longer present.  When a zebra needs to escape a lion, the stress response kicks in and it flees. If it survives, it very quickly goes back to its normal state, happily munching grass. It’s as if it’s forgotten all about the trauma it just went through.

If only we were as lucky.  How many times have you survived a stressful event, like a job interview, and then spent ages going back over everything you said, everything they said, the what ifs, the regrets, and the recriminations?  Our tricky brains have a way of keeping stress going even when the threat has passed. They can also create stress long before a threat even occurs – how often have you worried about something only to find it wasn’t that bad in the end?

This unfortunately means that stress continues to be experienced by our bodies, even when the stressor is no longer present.  This is the second key message: we need to deal with the stressor AND the stress

Key message 2: Deal with the stressor AND the stress

When we are faced with a stressor it is logical to try to get rid of it and to remove the source of the stress. If we can fight it and win, or escape by fleeing or freezing, that’s great.  As individuals we often put enormous energies into trying to eliminate the causes of stress. We problem solve, protest, avoid, study, appease, diet, plan, delegate, experiment, argue, plead, etc etc etc. When this works, and the cost of our actions doesn’t outweigh the benefits, we’re winning.

But often we can’t get rid of stressors this way. We can’t problem solve our way out of grief.  We can’t control the occurrence or impact of natural disasters, wars, pandemics, or punitive HR policies.  This can leave us feeling stuck in a stress response. Which in turn impacts our ability to cope with other stressors, resulting in ongoing, chronic levels of stress.

Even when we can get rid of a stressor, if we don’t attend to the stress it has caused, we don’t allow ourselves to resolve the natural stress response – again keeping us stuck, and at risk of burnout.

This explains why we may continue to experience symptoms of stress and trauma – such as agitation, poor sleep, hypervigilance, anxiety – even when the stressor is no longer present. If we don’t understand that this is our body’s stress response, our tricky brains can get to work filling in the gaps. This often takes the form of telling us we’re weak and failing, and need to work harder (AND that no-one likes us, AND we’re fat…queue the unhelpful loops).

What we really need to do, however, is help our bodies resolve the stress response. It’s usually no good trying to talk our bodies out of it – we need to do things.  In their book Burnout, the Nagoski sisters emphasise the importance of communicating to our bodies that we are safe. We need to bypass our tricky brains and speak directly to our nervous systems.  Good ways of doing this are:

• Movement
• Physical affection
• Crying or laughing
• Creative expression

Next steps

So, next time you notice your tricky brain settling into an unhelpful loop, and your body’s stress response being activated, remember to:

• Adopt a compassionate stance towards your response and remember it is not your fault that your mind and body are reacting this way
• Do what you can to tackle the stressor in ways that don’t add to your stress
• AND attend to your body’s stress response through active self-care
• Know that when the stressor is out of your control (or is no longer present) focusing on resolving your stress response can make a huge difference, so make this a priority.

The post Our tricky brains and the stress response appeared first on Dr Paula Redmond, Clinical Psychologist.

We can learn to be more comfortable with compassion by taking small steps, and building our skills slowly.  We also need to experiment to discover which aspects we find more difficult. Some people really struggle with imagery, others find connecting with their bodies very challenging.

The idea of the Ladder of Compassion is that you create your own hierarchy of steps towards greater compassion.  Starting with what feels easy for you, and practising this until it feels comfortable and meaningful. The next step is being able to draw on this during times of distress.

Once you’ve mastered one step you can move on to something more challenging that will take you deeper into compassionate practice. And again, practising this until it feels familiar so that you can more easily access it when you need it.

There will be days when the more challenging practices feel too much. When his happens you can take a step down the ladder to something that’s easier for you to connect with in that moment.

My Ladder of Compassion

This is my suggestion of steps to take in building greater compassion.  This is based on my experience working with many clients who struggle with self-compassion in particular.  However, you might find that a different order would make better sense for you. For example, breathing exercises might be particularly challenging if you are generally quite disconnected from your body. In this case you might find imagery work is easier to connect to.  Or you may want to skip imagery practices altogether.

I have put together a number of resources to help you with this process.  There is a lot of great stuff available online, so do take some time to find practices that resonate with you. If, for example, you find a particular person’s voice distracting – find an alternative. You may also want to record your own, or have a loved one record something for you.

Be aware that cultivating compassion is not the same as relaxation. You might find some of this work uncomfortable if it raises resistance and fear. Noticing this, and responding with an attitude of acceptance and kindness, is a really important part of the process.  But in all of this be gentle with yourself.  If an exercise starts to become distressing (rather than just uncomfortable) don’t feel you have to continue – stop and take a break or try something else.

Here’s how to get started

1. Noticing moments of compassion and kindness around you

If compassion feels unfamiliar to you this is a good place to start. As you go about your day keep a lookout for words, gestures and actions that embody the qualities of compassion.  Notice the steps people take to relieve theirs and others’ suffering.  Who in your daily life (or in the news) personifies warmth, wisdom, strength and commitment? Can you catch yourself being kind to yourself?

This is a great journaling task. You don’t need anything fancy – just a notebook, or your phone, to jot down all the examples you come across. You might find this sparks an inner debate: is saying no to a request selfish, or is it actually an act of self-compassion? Was your colleague really trying to show you up or was their offer of help motivated by kindness? How can leaders and governments respond compassionately in tumultuous times? Exploring these thoughts with yourself and others can be really helpful in deepening your understanding of compassion, and being more aware of your blocks to it.

2. Mindfulness exercises

Mindfulness is a core component of fostering compassion. It is the process of bringing your attention to the present moment without judgement. Through practicing mindfulness we can develop greater awareness of our responses, and in doing so unhook from the thoughts and feelings that pull us in unwanted directions. We also learn to cultivate greater acceptance of our inner experience – which is an important foundation for compassion.

You can practice mindfulness simply by bringing your attention to your present moment experience, by asking yourself what thoughts, feelings and bodily sensations are present for you right now, in this moment.  You can practice “everyday” mindfulness when doing everyday tasks such as brushing your teeth or washing the dishes.  Rather than getting caught up in your thoughts and operating on auto-pilot, focus on the sensory experience of the task.

You can also practice using mindfulness meditation exercises.  Here are some of my favourites:

• Five Minute Mindful Breathing
• Leaves on a Stream
• Mindful Walking

3. Soothing breathing

Using our breath is a powerful way of activating our soothing system to help calm us physiologically and psychologically.  From this place of supportive calm we will be more able to access a sense of compassion and kindness for ourselves and others.  By practising this as often as you can you will be able to draw on this skill during times of distress.

Here are some good examples:

• Soothing Rhythm Breathing audio with a man’s voice
• Soothing Rhythm Breathing audio with a woman’s voice 

4. Safe Place Imagery

In this exercise you use your imagination to create a safe place that can provide you with a sense of calm and rest.  This is another exercise that aims to activate your soothing system from which you can cultivate and nurture compassionate attention, thought and action.

• Safe place imagery exercise from Compassion Focussed Therapy
• Safe place meditation

5. Compassionate Self exercises

The next step is to focus explicitly on cultivating compassion. These exercises can be more challenging, especially if compassion is unfamiliar. But they are worth persevering with as they can have huge benefits for our wellbeing.

• Practice embodying compassion with this compassionate-self visualisation exercise
• Take a self-compassion break (there’s a text script and an audio version)
• Practicing a loving-kindness meditation can be a really powerful tool for taking care of ourselves in a compassionate way

I hope you find these exercises useful in creating your own ladder oc compassion. If you would like to consider whether therapy might be helpful for you in developing this further, do book in a call.

The post Building compassion step-by-step – exercises for developing a Ladder of Compassion appeared first on Dr Paula Redmond, Clinical Psychologist.

In other words, reducing our fears and resistance to compassion can build trauma resilience.

What is compassion and what gets in the way?

Psychologists have known for some time that compassion is an important buffer against poor mental health. Compassion is defined as “a sensitivity to the suffering of self and others, and a commitment to alleviate or prevent it” (Paul Gilbert). Put more simply, compassion is acknowledging pain, responding with kindness and doing something to help. It embodies the qualities of warmth, wisdom, strength and commitment.

Compassion is described as having three “flows” – being compassionate towards others, receiving compassion from others, and being compassionate towards ourselves.  These three flows are often out of balance. For example, many of us (especially health professionals) find it more difficult to offer compassion to ourselves than to give it to others.  Improving the balance between these flows will help to sustain emotional wellbeing.

On paper compassion sounds like a great idea, but it isn’t easy.  We are all likely to have fears and resistance to compassion, in varying degrees. We may, or may not, be aware of these.  But, as the study I mentioned above shows, these blocks to compassion can be harmful in themselves, as they reduce the protective role compassion can play when we are faced with difficult circumstances.

The good news is that we can learn to recognise these fears, work through them and take steps to cultivate compassion.  We can build psychological resilience through developing greater compassion for ourselves and others.  Compassion is a skill that can be cultivated through evidence-based interventions such as Compassionate Mind Training, and Compassion Focussed Therapy.

5 Steps to tackling your fears of compassion

1. Survey your fears – identify which of the 3 flows of compassion (to self, to others, or receiving from others) you struggle most with. Complete this questionnaire from the Compassionate Mind Foundation. The higher the score for each scale, the greater your fears or blocks in that flow.

2. Identify your fears – have a look at the items that you scored most highly on the questionnaire. What does this tell you about the beliefs and worries that get in the way of compassion for you? Generally people find that these fall within 3 common themes:

• Compassion is a weakness – we might believe that showing or receiving compassion makes us weak, self-indulgent or even selfish
• I/they don’t deserve compassion – we might believe that compassion is something that needs to be earned, and that giving undeserved compassion lets us/them off the hook for their responsibilities
• Opening up to compassion means opening up to pain – we might worry connecting with compassion will trigger painful feelings of anger, shame or loss.

3. Reflect on the history of your fears – once you know the nature of your blocks to compassion reflect on how these might have developed. Do these beliefs stem from things people have told you in the past? Did you grow up being told that showing compassion or accepting help was something to be ashamed of? Have you been led to believe you are not deserving of kindness?  Are you worried about what might happen if you let your guard down, because you’ve been hurt before? Are you worried about being overwhelmed by difficult and painful feelings if you start to open up?

4. Acknowledge and validate your fears – your defences against compassion are there for a reason, to protect you from harm. Acknowledge this and show yourself kindness for what you have been through. It’s totally understandable that you would be resistant – but know that you can take small steps to overcome this without being overwhelmed or putting yourself in harm’s way.

5. Take small steps on the compassion ladder – if you are open to developing greater compassion, for yourself and others, you can do this by taking small steps. If you practice regularly you will find that you are able to open up more, and reap the benefits, without being overwhelmed. Irons and Beaumont – in their great book The Compassionate Mind Workbook – describe the “Compassionate Ladder”. This illustrates how you can start with simpler exercises and work your up as you become more comfortable. And if you ever feel something is too difficult you can go back down a rung or two.  Everyone’s ladder will be slightly different, depending on their own experiences, so you may need to experiment. Here is my suggestion for what this might look like:

Next Steps

If you want to learn more about cultivating compassion I recommend The Compassionate Mind Workbook, by Irons and Beaumont.

If you think you would find compassion-focused therapy helpful book a free call to discuss how I can help.

The post Are you afraid of compassion? 5 steps to tackling fear of compassion appeared first on Dr Paula Redmond, Clinical Psychologist.

This definition gives equal priority to compassion for others and compassion for ourselves. For many of us, especially those in the helping professions, compassion for others is a key driver of our choices. But often this comes at the cost of taking care of ourselves.

Cultivating self-compassion means being kind towards ourselves, and allowing ourselves to receive kindness from others. It also means taking steps to prevent and alleviate our own suffering. As I’ve previously described, this isn’t always very nice. Sometimes being truly compassionate towards ourselves means doing things that feel uncomfortable, such as setting clear boundaries and saying no to others.

So while compassion is about kindness and warmth it also embodies the core qualities of wisdom, strength and commitment.

Take a moment to consider what actions embody this for you? Who do you know, either personally or in the wider world, who represents these qualities? Can you think of a time when you have acted in a compassionate way towards yourself, even when this might have been difficult?

Treating yourself like a friend

Kristin Neff is the lead researcher in the field of self-compassion. She describes self-compassion as giving ourselves the same kindness and care as we would a good friend.  This is much easier said than done, and we need to treat compassion as a skill to learn and practice.

Compassionate practice is not the same as relaxation – in fact it can feel very uncomfortable at times.  During a time of difficulty have you ever found yourself managing to hold things together until someone is kind to you?  When someone who cares about you has a sense of your suffering and acknowledges this through kind words or gestures we can find ourselves instantly in touch with our pain.

This is a phenomenon known as “backdraft”.  Backdraft “is a rapid or explosive burning of superheated gases in a fire, caused when oxygen rapidly enters an oxygen-depleted environment”. When we open ourselves up to compassion we also open ourselves up to pain.  This is why we often work to shut compassion down, so that we can avoid our pain.  But unfortunately we’re not able to selectively shut down emotions – blunting one part of ourselves inevitably leads to blunting other parts. This in turn leads to disconnection.  If we can leave the door to compassion always open, even just a little, this will help foster a more healthy flow of emotional experience.

It’s hard to be friends with someone who shuts things down when they get difficult, because this doesn’t allow for deep and authentic connections.  A deep friendship will make room for all the feels – good and bad.  If we can offer this to ourselves we will be able to connect more with the things that really matter to us.  Here’s how…

How to cultivate self-compassion

Self-compassion has three components: mindfulness, common-humanity and self-kindness:

Mindfulness: being able to acknowledge your current experience without judging or criticising it.  This can be as simple as taking a moment to notice what thoughts and feelings are showing up for you.  Grounding techniques can help to do this in a way that keeps you present, without being swept away in an emotional storm.

Common-humanity: recognising that being human means experiencing pain and being imperfect. It also means that you share this with every other person on the planet, past, present and future. You are not alone in your suffering, however isolated you might be feeling in this moment.

Self-kindness: directing warmth and gentleness towards your suffering. Consciously consider what it is you need in this moment – is it a reminder that you are good enough? Is it forgiveness, rest, or a soothing gesture?

There are many ways to put these ideas into practice. It can be as simple as taking a moment to consider these three steps – a self-compassion break is a great way to do this.  You may want to take some time to do a guided meditation focussing on self-compassion or write yourself a compassionate letter.

Make it a daily habit

We could all benefit from more self-compassion in our lives – embedding a daily practice is a great way to strengthen this skill.  Could you find a way of including this in your daily routine – e.g. when you’re having your morning cuppa, brushing your teeth before bed, or on a coffee break during a work day?

If you are able to practice regularly you will find you can draw on this skill when you really need it during times of stress or difficulty.

The best places to start for resources and exercises are:

• Kristin Neff’s self-compassion.org
• Compassionate Mind Foundation

If you are looking for more support in developing self-compassion, therapy (particularly compassion-focussed therapy, or CFT) could be really beneficial.  If you want to chat with me to see if I might be the right therapist for you, book a free call.

The post Cultivating self-compassion appeared first on Dr Paula Redmond, Clinical Psychologist.

But I’m working on it.

I have come to realise that being nice has cost me a lot. I find myself saying yes to requests for help, even before my brain has fully registered what has been asked of me.  I often compromise on my own needs for fear of upsetting people or letting them down.  I find it virtually impossible to tell people if they’ve let me down, which can erode authentic connections.

One of the things that haunts me in the early hours is the thought that one day I might unintentionally put my children in harm’s way because my desire to be nice to others has blinded me to their needs.  I worry I won’t spot something dangerous because I’m too focused on being nice.  But in the light of day I wonder if this shows up in more subtle ways – if I’m less present for my family due to saying yes to others and over-working.

Professionally, I hate the idea of being thought of as “nice”.  It’s really important to me that I am effective in my work – that I can contribute in a way that makes a meaningful difference to people’s lives. Sometimes being truly helpful means risking conflict, rejection or emotional discomfort, which never feels nice.

There are many reasons for my nice-ness. Cultural, societal and family scripts have a big influence, as do individual factors such as my innate personality and life experience.  But while part of my being nice is about the relational roles I adopt, there is another part of me that really values taking care of others and avoiding harm. I don’t want to let this go. I want to find a way to be both caring and effective – for myself and others.

The concept of compassion brings these two aspects together in a coherent and enormously helpful way.  Compassion is defined by psychologist Paul Gilbert (of the Compassionate Mind Foundation) as: a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it.

There a few important things to note about this definition:

• Compassion applies equally to ourselves and others. For many, especially health professionals, the focus of our compassion is on others.  But in order to practice true compassion, and to lead balanced and fulfilling lives, we need to give as much attention to being compassionate towards ourselves.  We also need to allow ourselves to receive compassion from others.

• This definition describes two different, but related states of mind:

1. Engagement with distress – the sensitivity towards our own and others’ suffering. This includes being able to notice and stay present with suffering, and involves empathy and feelings of care.
2. Alleviation of distress – the commitment to stopping and preventing your own and others’ suffering.

Being nice does neither of these things. While it can appear as caring, it is usually more about the avoidance of discomfort.  Compassion, on the other hand, offers us a way to balance our own needs alongside those of others, and to be both caring and effective.  It embodies the qualities of warmth, wisdom, strength and commitment.  When I think of what’s truly important to me about being “nice” it is these qualities that resonate: I want to be warm, wise, strong and committed.

But compassion also takes courage, because intervening to alleviate suffering isn’t without risk.  We might risk having to deal with our own and others’ discomfort – but discomfort is not the same as suffering. Discomfort can be an important signal that something needs addressing or that things need to change. Often, if you’re like me, we use nice-ness to alleviate our discomfort – but imagine if we could act with compassion in these moments instead. What might that look like?

• Saying no to that request for help, in the knowledge that saying yes would mean feeling resentful
• Gently letting a colleague or friend know that they have hurt you or let you down in the service of maintaining an authentic, open relationship
• Leaving work on time because over-work causes you and your loved ones suffering, and makes you less effective in your job
• Challenging racist, sexist or homophobic jokes rather than staying silent
• Accepting help when it’s offered. Asking for help when you need it.

Managing discomfort

If reading that list makes you feel anxious, you’re not alone.  Embodying warmth, wisdom, strength, commitment and courage in the service of compassion might not always be a nice feeling.  One way to manage this is through mindfulness.  The Dropping Anchor exercise is particularly helpful. It helps to keep us grounded in the present moment when we feel swept away by difficult feelings.  The exercise can enable you to acknowledge the thoughts and feelings that are present for you in that moment, connect with your body, and engage with your senses. In this way we can unhook ourselves from the pull of that discomfort and more freely choose to act in line with what really matters.

You can find audio recordings of the dropping anchor exercise here, under ‘MP3 Recordings’.

It’s also important to be really kind to yourself when you are trying new ways of being and doing.  Remember to watch how you treat yourself and how you talk to yourself.  Adopt a compassionate stance towards your compassionate choices, especially when the outcome doesn’t feel nice.

Compassion is a skill that can be learnt and developed. In future blogs I will explore how to do this, but if you are keen to learn more now I highly recommend The Compassionate Mind Workbook, by Irons and Beaumont.

The post Why compassion isn’t nice appeared first on Dr Paula Redmond, Clinical Psychologist.

These are awful findings – a third of our doctors are suffering from depression and burnout.  And sadly 20% of those who completed the survey said they’d had thoughts of suicide. The distress and suffering this causes is best illustrated by the doctors’ own words:

“I feel like a trapped animal sometimes”

“I’m no longer the person I used to be”

“I sleep a lot, and it doesn’t take much to make me cry. I snap at everyone”

It doesn’t need stating that the Covid-19 pandemic has put enormous physical and psychological strain on all health professionals. Survey respondents reported that amongst the issues contributing to burnout were too much bureaucracy, too many hours at work, a lack of control and feeling like just a cog in a wheel.

But the factor identified as contributing most to burnout may surprise you: a lack of respect from colleagues (including co-workers, managers and administrators).

My response to this was initially one of sadness and anger. Doctors endure the gruelling and relentless demands of their jobs – that currently place them at considerable personal risk – and yet also have to survive rudeness, bullying and unkindness from those who are supposed to be on the same team.  It’s tempting to conclude that this is a result of bad apples – a few nasty people victimising others. Certainly there are those working in the NHS who routinely mistreat people, and who rely on bullying behaviours to meet their own needs for power and control.  I think it’s also true that the NHS doesn’t do enough to tackle this.  However, as I continued to explore the survey data, a more nuanced picture emerged.

Doctors who described themselves as being depressed reported that this had a significant impact on their workplaces and colleagues.  They described being less engaged, less friendly, and more exasperated and frustrated.  For colleagues on the receiving end this is likely to be experienced as a lack of respect.

Thus a vicious cycle emerges: a lack of professional respect contributes to depression and burnout which in turn leads to disengagement or hostility towards colleagues.

What can we do about this?

Here are 3 suggestions:

• Many of the factors that contribute to burnout and depression amongst doctors are massive systemic issues. Individual health professionals have very little, if any, influence over these problems. But we can manage our own behaviour and responses to colleagues.  If we were all able to prioritise kindness and respect towards each other, even in the midst of overwhelming demands, we might be able to ease at least some of the burden.

• Respect is demonstrated in lots of ways. It’s not just about not being rude. It’s also about honouring agreements, enabling people to meet their basic needs (food, water & rest), and recognising workers as people first – names on a shift rota second. If you have responsibility for managing operational systems and logistics, you have frequent opportunities for demonstrating that your colleagues are valued and respected. Take these opportunities – they mean a lot.

• If you notice that you are disengaging from colleagues or responding in ways that don’t feel right this might be a sign that you are struggling with depression or burnout. Reach out for support – to colleagues, friends, family or a professional.

Sources of professional support include your GP, Practitioner Health, Project5, Frontline19, or a private therapist or counsellor. If you would like to talk to me about whether I might be able to help, you can book a free 20-minute call.

The post How lack of professional respect contributes to burnout in doctors appeared first on Dr Paula Redmond, Clinical Psychologist.

This is how I’ve been feeling over the last few days. As the new Tier 4 restrictions were announced I was struck with sadness and disappointment that our Christmas plans would have to be cancelled. It had taken me a while to get into the Christmas spirit in the first place. Without the extended family gatherings, the Christmas markets, even the awkward office parties, I wasn’t feeling very inspired.

But as it got closer I started to look forward to our paired-down plans. I was feeling good about making our own crackers (filled with bizarre trinkets I’d scoured the charity shops for); watching my parents and grandparents open the gifts I’d thought hard about; and even making my annual pain-in-the-arse-but-oh-so-yummy marzipan mousse. I knew my kids were excited about waking up on Christmas morning at their grandparents’ house – wondering if Santa would find them there.  And then all these plans evaporated.

Now I feel stuck and depleted. I can’t problem-solve a way out of this one. I can’t pretend that things are magical. But I don’t want to stay feeling like this either.

I am very grateful for all that I do have, and I know that 2020 has been much kinder to me than to many others. My gratitude sits alongside my sadness and fear, it doesn’t quash it.

So, how do we find peace, joy and goodwill when we feel sad and helpless?

A Compassionate Approach

I can’t offer any simple life hacks, but I think there is wisdom to be found in Compassionate Mind Training. This approach describes how we have three basic emotions systems: threat, drive and soothing.  These systems each have different, but important, functions. The threat system alerts us to potential danger and urges us to take action to protect ourselves. The drive system enables us to attend to opportunities in our environment and motivates us to pursue our goals.  Finally, the soothing system helps us to experience safety and contentment.

Adapted from Paul Gilbert’s The Compassionate Mind (2009)

We need all three systems to be in balance for us to function well.  Very often, however, these systems are out of balance, and we find that our threat and drive systems are more often and more easily activated than our soothing system. In fact, for many of us, our soothing system wastes away from disuse, so that in times of stress when we could really do with some soothing, we’re so horribly out of practice that we struggle to access it all.

Instead, we may cope by doubling-down into drive mode through making plans and lists; problem solving; or goal-setting. Or we might cope through frenzied distraction and emotional numbing. These strategies can quieten down our threat system for a while, but they are not truly restorative or soothing.  And in times like these no amount of Q1 planning or Netflix bingeing is going to make the reality of Covid-life go away.

Ordinarily at this point I would probably offer some advice about ways of cultivating your soothing system. But right now, so many of the things that would normally be helpful are the very things that have become threatening – spending time with loved ones, affectionate touch, pursuing adventure and new experiences.  How do we survive and keep going without being overwhelmed by our threat system, when our drive system is of little use and our go-to soothing strategies are out of bounds?

The Emergency Kit

If we return to the desert analogy – once you’ve got over the initial shock of the mirage, what do you do? Maybe all you can do at this point is to recognise that there’s nothing you can do, and that for now you just need to rest and be.  Not easy or comfortable when you’re in the middle of a desert. But you realise that you do still have the emergency pack you’ve been carrying with you all this time. It’s not much, but you’re able to create a little shelter from the hot sun and have some water and food rations. As the day cools you’re able to get some sleep, and maybe feel a little more ready to tackle tomorrow.

If you’re feeling sad and helpless too, try to give yourself permission to let go of the drive to fix this now. Allow yourself to attend, as much as you can, to your soothing system. Prioritise this over chores and life admin and Christmas preparations.  It probably won’t feel comfortable to start with, but try to give yourself:

• shelter – through carving out time, prioritising your needs, taking a break from being online,
• nourishment – connecting with people, animals or ideas that bring you joy, and
• rest – through calming, enjoyable activities that don’t necessarily achieve anything

Peace, joy and goodwill may follow.

I’m going to try to take my own advice. I’m going to go for morning walks, read a novel instead of the news, and, well, maybe that’s enough.

Next Steps:

If you are interested in finding out more about Compassionate Mind Training, I recommend The Compassionate Mind Workbook by Chris Irons and Elaine Beaumont.

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