8 - Barriers to Our Own Therapy as a Family Member
Research shows that families who believe in a persons ability to get through an altered states experience have better outcomes and get through it faster. As such, please know that you as a family member have a lot of potential to help make things better. I commonly hear family say they want the individual with the lived experience to make the changes and go to their own therapy. But today we are going to talk about why you may hesitate to start your own therapy. Please answer the following questions about yourself as the family member.
Journaling:
If research shows that me having my own individual therapy can help the family as a whole, why do I not start that? Do I worry about what topics might come up in my own therapy? What specific topics do I worry about?
Are there regrets that I have made as a family member? Are there specific instances that I wish I had done differently? Please list them here briefly. You don't have to go into detail if you don't want to.
Can I offer myself kindness and compassion around feelings of regrets or mistakes? Do I feel others could offer me kindness around them? Can I remind myself that we all make mistakes and that is human and normal?
Can I forgive myself for choices I made in the past that may have hurt my loved ones? Is forgiveness a topic your family believes in? In what ways do you all show forgiveness to one another?
Are you afraid that you caused your loved ones altered state? Do you ever talk about this worry? Is it possible that your mistakes harmed your family members in some ways but that potentially did not cause their altered state?
What if we are not powerful enough to cause an altered state on our own? What if all families make mistakes and our family members don't all end up having altered states? What would that mean about mistakes and potential outcomes? Might it mean there is more to a situation than just the influence of family or potential mistakes?
What if the altered state being here is not about fault or blame but is about us now making changes to help it lessen? What coping skills might we ourself want to learn so that our loved one can eventually learn it for themselves from seeing us do it?
Do you get a chance to talk to your loved one with altered states about your own regrets or worries about impacting them? Might you want to check in with them about it? Would you want to reach out to their treatment team to see if you can join their discussions at some point to talk more about it all together?
Please know it might be very difficult to start talking with our loved one about this topic so please consider bringing it up gently if you do decide to talk about it. It’s very common to need multiple discussions before we can talk about it comfortably and openly. Being patient and calm can make it easier in the long-term. And asking our loved one if and when would be a good time to talk about it can help them not feel blindsided by the topic or pressured to have the talk when they aren’t ready in that moment. We want everyone to feel ready for the discussion or it should wait until another time.
Changing our focus:
Notice the feeling in your feet. Try wiggling your toes, arching your feet and moving them side to side. While you do this notice the individual feelings of the movement. Can you feel each individual toe or do some just seem all lumped together? Can you notice specific touch against your heel or on the top of your foot? Now do the same for your fingers. Notice how the movement impacts not only your feet or hands but also you legs and arms as well as your abdominal muscles too sometimes. Now notice the details of how your hands or feet look. Pay attention to lines, different shading, any wrinkles as you move. No need to judge, just observe. The point is to allow ourself to shift our attention to something else that is relatively neutral or even boring. That way we have more opportunity and practice at changing our focus for other times when we may want to in the future.
7 - Have you heard this information before?
Here are several quotes that many people who go through altered states may not be aware of:
“It is important to remember that psychosis is a treatable condition and if help is sought early, an individual may never suffer another episode.”
-Yale School of Medicine (2019, September 24). Specialized treatment in early psychosis (STEP). Retrieved from https://medicine.yale.edu/psychiatry/step/psychosis/phasis/
“Having a schizophrenia label is correlated with childhood social adversity, childhood abuse and maltreatment, poverty, and a family history of migration.”
-Hickey, P. (2017, January 10). The biological evidence for “mental illness.” [blog post]. Retrieved from http://behaviorismandmentalhealth.com/2017/01/10/the-biological-evidence-for-mental-illness/
Factors that influence shift into psychosis: Cannabis Use, Urban living, Childhood trauma, Affective and Anxiety Symptoms
van Os, J. & Reininghaus, U. (2016). Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry, 15(2), 118-124. Retrieved from doi.org/10.1002/wps.20310
“Following recovery from a first episode, a significant number of people will never experience a recurrence of psychosis.”
Mental Health Evaluation & Community Consultation Unit – MHECCU, (2020). Early identification of psychosis: A primer. Retrieved from https://www.health.gov.bc.ca/library/publications/year/misc/Psychosis_Identification.pdf
Journaling:
Have you ever heard this information? What do you feel about it? Do you think this applies to your situation around altered states experiences?
Do you think your family is aware of the information in these quotes? Has anyone ever point out this perspective to you before? Did anyone (doctors, hospital staff, etc) ever tell you the opposite?
Is this something you would want to discuss with your treatment team? Would they be surprised by any of this information?
Is there anyone else in your life that you would want to read these quotes? Do you feel they would be open to the information?
Would you ever want to read these original articles? Do any of them appeal to you more than the others? Why do you think that is? What do you think it might feel like if you did look them up?
Are there any factors that you feel are important that are not included in the quotes?
Changing our focus:
Please notice your breathing for a few moments. Pay attention to how your body moves with each in-breath and then again on the out-breath. How often do you pay attention to this sort of thing? Does noticing it make you change to either deeper or more shallow breaths? Do you ever pause to notice your breathing throughout your week? Does it feel relaxing at all? Does it allow you to shift your focus away from what you were just paying attention to? Are there certain instances that might be nice to focus on your breathing throughout your week? Have you ever invited friends or family to do a breathing exercise with you? Would it be worth trying?
6 - Duration of Untreated Psychosis (DUP)
The Duration of Untreated Psychosis (DUP) is the term for how long someone goes through an altered state experience before they officially start effective treatment for it. In Western Lapland in Finland, where Open Dialogue is practiced, the time between someone starting to have very uncomfortable experiences until they start effective and supportive treatment is 3 weeks. In the US, it is 74 weeks. That is a very big difference. Being able to look at how this initial time period in your life went and how things have gone since then can be a big piece of working through grief at how difficult that time might have been. No matter how long it took for you to engage with supports that feel good to you, please know you deserve compassion and gentleness at all times.
-Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keränen, J., Lehtinen, K. (2006). Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychotherapy research, Taylor & Francis
Journaling:
How did your own personal experience of altered states start? What did you notice first and what was your reaction? Did you tell others about it? Why or why not?
Have you talked about that time with your family or friends? Do they feel that they noticed you going through that experience also? Did they try to talk to you about it? Did they try to bring it up with compassion and kindness?
How long did it take before you were involved in some type of treatment? Was it a caring form of treatment? Was it scary? Did you feel the first treatment you received was helpful?
Is this a topic you feel comfortable sharing with others? What suggestions might you offer others who experience altered states?
Do you feel able to tell your treatment team (could be a therapist, peer support worker, nurse, psychiatrist, wellness class teacher, etc) about this initial time period in your experience? Do you feel they listen well and offer compassion? If you want changes in your treatment are you able to express that comfortably?
Changing our focus:
Please have a look above you. If you are in a building, please notice all details of the ceiling. What parts are dim vs lit up? Are there any aspects that you hadn’t noticed before like a different pattern or an unusual shape? Is it all one color or does it change? If you are outdoors, look at the sky and notice if there are clouds, planes or birds? Does the color shift at any point? Is it easy to look all around or are there spots that are hard to focus on because of the light or hard to see clearly because of darkness? Remind yourself that being able to just notice is a thing we can do at almost any time. And taking a short break just to be mindful and aware of details sometimes can allow us to feel relaxed no matter what we were just thinking about. Please spend a minute or two savoring just the details even if they are boring.
5 - The Stress-Vulnerability Model
This idea basically says that as stress increases, if we reach a point where we are overwhelmed by it and unable to cope effectively, then mental health experiences will arise. All people are on this line and for each of us the type of mental health experiences that occur can be very different. If these experiences are not addressed then they will continue to increase in intensity. This is a Continuum Model of mental health.
In talking about altered states (for example, schizophrenia, psychosis, voice hearing, visual experiences, paranoia and extreme beliefs) the author Landa, states “...at different levels of distress all people are capable of having such experiences.” So she is pointing out that any human can go through psychosis if the stressors are high enough and if our coping skills aren’t able to help us resolve the situation. This is very important to remember since so many people who go through altered states feel like they are alone and different than others. So please know that millions of people have gone through this and so many of them work their way out of it.
- Landa, Y. (2017). Cognitive behavioral therapy for psychosis (CBTp): An introductory manual for clinicians. Mental Illness Research, Education & Clinical Center. Retrieved from https://www.mirecc.va.gov/visn2/docs/CBTp_Manual_VA_Yulia_Landa_2017.pdf
Journaling:
Have you ever heard about this model? Do you feel it might be accurate in your own life? In the lives of your family members?
What situations in your life feel like they may have been too much to cope with for you at that time? Do you feel like you would be able to cope with them more now? If yes, why is that? What may have changed so that you feel more able to cope now? If not, are there things you’d like to learn so that you can cope more in the future?
What are several main ways your family members cope with stress? Do you all talk about stress when it comes up? Are there unspoken rules about who can bring up stress as a topic or who is allowed to experience stress and who isn’t? What ideas do you possibly have about how you all as a family can deal with stress better?
Do you have any specific coping skills that you feel are especially helpful? Do you ever share them with others? Are there any that you can teach to your family or friends?
Do you feel your treatment team (anyone who is involved in your overall plan to help get the life you want) is aware of the Stress-Vulnerability Model? Would you want to educate them on it? Do you feel they would be open to that and listen?
If you wanted to look up information about this model what questions would you want to answer? Where would you look?
Changing our focus:
Check in with how your surroundings are feeling next to you right now. Notice the details of the clothing you are wearing and the feel of it. Pay attention to any jewlry you might be wearing to see if it feels heavy or light. If you have socks on are they tight or comfortable? Is the temperature warm, cool, comfortable or irritating? Is the thing you are sitting or standing on hard or soft? None of these things are especially important in the larger view of life but just this moment paying attention to them can give you a break from your thoughts and what you were just focused on. This can be a great thing to practice. Take care.
4 - Celebrating Yourself
Being able to appreciate and celebrate successes can have a huge positive impact on our sense of worth. Finding ways to celebrate yourself is a big part of that. Here we are going to look at how we celebrate ourselves so we know what options we like and also see if we can identify some new ones.
Please write a list of ways you, or family or friends have celebrated themselves. Include what you liked about that style. These can be big things like throwing a party or small things like pausing to watch a sunset. Partly it is just things you can do to enjoy the moment but we want to remember that celebrating ourself can be about rewarding our hard work or choices that helped us get something we want.
Examples:
-My friend always has coffee in the morning on weekends to celebrate that they are off work.
-After graduation my cousin had a small party with her friends.
-When my aunt finished her craft project she presented it to us all and we clapped and cheered.
-I treated myself to my favorite dinner last week after sticking to my goal of tidying the living room every day for a week straight.
-My kids and I all yelled, "Wohoo!" and danced a little after we finished the dishes.
List examples of how I have celebrated or how I have seen others celebrate something:
Are there any people in your life who are really good at celebrating themselves? Might you want to ask them about it?
Are there any things that are coming up in the near future that I want to celebrate? What way might I choose?
How would you want the celebration to feel? Happy, relaxed, peaceful, loud and boisterous?
Changing our focus
Please go back and read over what you wrote. Notice the positive feelings as they are there. You can keep or get rid of the writing, totally your choice. Now please write a bit about your favorite type of weather. What do you enjoy about it? What parts do you appreciate the most? Does your travel or commute change very much during that weather? How long until you expect to get to enjoy your favorite weather again? Did you always enjoy it or did it change with age?
Remember, the point of changing our focus after the original writing is to shift to something that might feel neutral or easy to focus on. That practice is really good to have so we can do it more in life when things come up that can be stressful.
3 - Things I’m Proud Of
Today we are writing about things you are proud of. These can be things you have achieved in your life, positive things others have said about you, things you like about you or anything that makes you feel good about yourself. Our goal is to have a good list of things that when you think of them you smile or feel happy about you.
Please write as much or as little as you want. Including more detail can sometimes help you remember it better and also enjoy it for longer. It's especially helpful to include things that are related to choices you made to achieve the positive (example, Because I studied for the test our class all got ice cream when I was in 5th grade). I'm including several prompts here in case they help.
Something people told me about myself that I'm proud of:
Something I remember from when I was really young that I'm glad I did that way:
An example of a time I was really kind to someone else that stands out to me:
A thing I changed about my life that brought about positives that I'm proud of:
A time when I helped someone and I'm glad I did:
A great compliment I got once:
An award I'm proud of having gotten:
A time when I'm proud of standing up for something that I believed in:
Changing our focus
Once you are done please read over the things again just to be reminded of them and savor any enjoyment. You can keep this writing or shred or delete it. The point is the activity and the memories, not having to keep it. Then please look around your space and see what you notice that is shiny, what things look fluffy, what items look like they would be cold to the touch. Can you find 10 of each? Our goal here is to have practice at focusing on one topic (the journaling) and then comfortably moving onto another topic (the mindfulness exercise). Take care!
2 - Describing Yourself
Todays prompt is about describing how you see yourself. This can include positive, neutral and uncomfortable views but please remember to include at least some of each.
What are some things you like about yourself?
Are you always able to remember them? Is there a way to remind yourself of them more often?
What things are neutral about you? (Basically things that are possibly common about you and make up a lot of who we are. For example, I like peanut butter and jelly sandwiches. Pretty neutral but definitely true about me.)
What things about you make you feel uncomfortable or frustrated?
Can you be kind to yourself when you think about them or are you judgmental?
Do you notice when you make progress in areas that used to be frustrating and now you do better at?
Changing our focus:
Once you have finished writing about these topics please pause and have a look around your space. Notice the shapes of things. Notice the colors and textures. These things are usually pretty neutral but can still have a calming effect on us. Now write a bit about how it feels to be relaxed and calm (even if you aren’t feeling that right this moment).
1 - Preferred Wording
Going through any type of emotional experience can be very difficult. At times we might get a diagnosis and then people start to use that wording much more often. In our prompt today please write about labels and terms that you have had associated with you and your opinion of them.
Labels you have been given.
Do you agree with them?
Do you feel they are accurate?
Do they change the way you feel about yourself?
Are there other terms you would like people to use when they refer to your experience?
Can you ask them to do that or does that feel impossible?
Have there been times that others did use wording you preferred and how did that feel?
Changing our focus:
After you have written as much as you want then please write about something you are grateful for or proud of yourself about. You deserve to shift the focus after thinking about more difficult topics. Take care.
Welcome!
Welcome to the Journaling section of our website. Our interest is to offer journaling prompts for you that allow you to gain insight into your past, where you want your future to go, and things that are sometimes difficult to share with other people.
Please allow yourself a comfortable space to think about the prompt and then write whatever comes to mind. You do not have to share your writing with anyone. If you have someone you consider safe and want to share it with them that is your choice. Reading it to your therapist can also be very helpful. Please remember though that you may have to help the therapist understand how you are feeling about it now since sometimes journaling can bring up emotions that may sound more intense than we feel at a later point.
After you finish with the prompt please spend a bit of time changing the topic and either writing about or thinking about something you are proud of, something that makes you happy or something you are grateful for. This allows you the chance to shift your focus back to your daily life and more ease.
Some people keep their journaling entries and others delete them or shred the paper. You can do whichever you prefer. The goal is for you to have an outlet for your thoughts and then be able to move onto other things after the journaling. If you find yourself getting upset after journaling or have difficulty changing your focus back to your surroundings please consider if it is not a helpful activity right now in life and choose something else that is less uncomfortable. You can always try journaling again at a later point to see if it goes better at that time.
Sending you caring.