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Just to have someone to talk to, to talk at, to talk through a thought that’s holding you up, is so beneficial to my mental well being. I experience the benefits of this through conversations with my wife, my family, and a couple of close friends. It’s rare that these conversations end in some complete feeling of freedom from worry or some total resolution. In fact, conversations that go in that direction lead me feeling invalidated and misunderstood. More often, the issue is left sitting on the table, but unlike before, it’s no longer mine alone. In my case, I’m okay with the issue laying there because I feel better.

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Externalizing

 

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Context: this occurred over a 50 minute session with a brilliant and creative 12 year old girl with ASD. We’ll call her Sue. It began as a conversation about fashion. The topic was “fashion snobs”. As is always the case, Sue has a drawing app open in front of her so that she can draw and talk. She begins to draw this “snob”, who is described a lot like a recurring character in a Nickolodian sitcom (the stereotypical high school “mean girl”). While embellishing her topic of interest, I mention how curious I’d be to see “the nice girl”. I say that I’m going to start to draw her as Sue continues drawing the “mean girl”. I ask sue for help along the way – just small details that describe this “nice girl”.

The above image is what we came up with. Interestingly, this is very representative of the girl Sue wants to be and often is when she’s on her game. The picture represents unique ideas about right and wrong, social expectations, personality eccentricities, wishes, interests/passions, insecurities, etc.

Through simply trusting the process of engaging an individual in her interests and being curious (DIR-Floortime), we are able to create a character that starts a conversation about who Sue is, what’s she’s aware of regarding herself, and the person she’d like to be more often. This is not only a fascinating process but also a therapeutic one. Sue tells her story to someone who can help her record and reflect on the way she experiences the world. She talks about her insecurities without feeling exposed. She creates a narrative role model. Lastly, she gets to see how close she already is to her ideal self.

Dear Reader,

Stories or “narratives” are created throughout our lives. They are constructed by our experiences, the relationships we have with those around, societal/cultural norms, our values and beliefs, etc. Often, these narratives can take on a negative flavor and cause us problems. Narrative therapy works to help the individual tell his/her story while externalizing the problem (Separating the problem from the individual. Think of Rock Brain in the social learning curriculum) and coming up with alternative stories. This practice believes that by helping you author and tell your story (becoming aware of the narratives you hold), with supportive feedback and perspective from others around you (who do not guide or shape your story), that you can find a way of writing a new narrative that works for you. It may come as no surprise to those who work with me that I prescribe to this philosophy strongly in my cartooning work with kids.

Check out this great slideshow explaining Narrative therapy in more detail:

Event: Take off.

Calming technique: Deep, slow belly breathing (in through the nose all the way down to the belly button, slowly out through mouth). Eyes closed.

Visual imagery: Imagining plane slowly pulling up from the run way to the sky and leveling out.

Negative Automatic thoughts (NATs): Thoughts and image of plane crash occur in the midst of visual imagery and breathing.

Calming technique: Continue deep, slow belly breathing. Eyes closed. Allowed NATs to come in, and go out. Did not question whether this would occur. Just accepted that the NAT was present, continued breathing, continued positive imagery.

Reality/Outcome: Smooth leveling occurs within 20 seconds to 1 minute.

Eyes open.

Normal breathing begins.

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The above visual is one I made to explain how awareness is the key to insight which leads to change. 

It’s no surprise to those who work with me that my favorite tool for trying new things, battling anxious thoughts, and pushing (gradually) to overcome worries, is AWARENESS. I feel this way because awareness of our environment, our bodies, our thoughts, our triggers (those things that set off the cascade of worries), and our behaviors are really the only true control we have. We can’t control what is outside of ourselves (as much as we may try). The nice part about becoming more aware or mindful of yourself is that it allows you to prepare or plan. “What will I do if i start to feel this way? If i start to feel X in my body, i know it’s likely my worries activating my physical system. If i’m aware that this is a normal part of anxiety and I am safe/not in danger, I can find a way to override this feeling, completely remove myself from the trigger, or take a break and return when I’ve regained control.”

In other words:

IF WE ARE AWARE, WE CAN PREPARE. 

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There is no-play-by play manual to parenting. You set the ground work with clear expectations and predetermined consequences (not in the moment reactive ones). You praise and reward, with tangibles and intangibles, mostly with love. You validate feelings and put language to when your child is overwhelmed and cannot express why. You console and love.
You remain steadfast and consistent with what you say and do, to the best of your ability. This requires you to battle some major waves of opposition at first.
You make calculated predictions based on history of behaviors in certain settings, with certain people, under certain conditions. You try your best to prepare your child beforehand to succeed in these setting with these people, in these conditions.
You discuss with them afterwards on whether the prediction was correct, how they handled it, how you handled it,and possibly any alternative ways to try next time around. You do this all with a hug, with reassurance and love, with a stern but patient tone.

Just some thoughts I wanted to write down. Please add your own in the comments section.

HR 2

A while back I bought a heart rate monitor. I wanted to see if there was any correlation between the physiological response that one has when feeling anxious and heart rate elevation. I was excited to have a possible tool that would help those with anxiety self-regulate. In my case, it turned out that the correlation was not very strong. On several occasions over a period of months, I strapped myself up when feeling uneasy or anxious and saw heart rates similar to that of a Yogi. The heart rate clearly did not match the feeling I was having and was therefore a poor tool for detection.

I was bummed, because I felt like this would’ve been a great tool to help others (especially the kids I work with who were not so aware of the cues their bodies often send) have a way to self-monitor anxiety. Imagine an alarm going off on your wrist that tells you, take a break, with concrete numerical data (not parents or teachers) to back it up.

Instead of giving up, I tried something else. I began testing what it would be like if I matched my heart rate to my feeling. For example, if I was feeling anxious, I’d sprint or climb stairs rapidly in order to get my heart rate up. If I could do this, maybe I could then control/bring the heart rate back down, and in doing so find a sense of self-regulation (taking back control of my body’s ascending and descending heart rate). A feeling of control is what is often lost when anxious thoughts and feelings arise.
This is still an experiment in progress but it seems to have some legs. I’ve noticed that by increasing my heart rate to fit my level of anxiety or nervousness, I am then forced to sit back, breath deeply, and let my heart, my lungs, and my muscles come back down to regulation.