Therapists are big on advising clients to “be kind” to themselves, practice self-care etc. Bookstores are full of self-help books that give suggestions on how to get better at self-acceptance, self-compassion and self-care. Advice may range from “taking time for yourself” to arranging a better sleep routine, booking regular holidays and making sure your work/life balance is in check.
If we have got such an abundance of self-care advice out there, then why do more and more people feel exhausted, burned out and struggling? Many clients come back to therapist’s office and complain: “I am making all this time for myself, but I am still depressed and teary” or “I have regular breaks from work and take myself out to holidays but I am still tense and stressed every day”.
Perhaps simply going through the motions of self-care activities is not enough for mental wellbeing? Perhaps there is something else that we need to address when looking at our emotional state? Perhaps self-care it is not only about what a person is “doing” for themselves but rather how they “treat” themselves. What is their attitude? Do they threat themselves with love and compassion? Are they a loving and caring companion when they are alone? Are they able to enjoy own company?
When Karen, 37 walks into my office and talks about stress and anxiety that permeates her daily life I usually begin with asking her about her lifestyle. She is describing a fairly busy life, filled with much work, but also enough leisure. Karen heard a lot of wellness advice and is fairly keen to look after herself, whatever that means. She is often social, often active and is often happy with her life. She eats, sleeps and exercises well, she plans regular holidays and time off. However her mental health continues to suffer from anxiety and her mind constantly seems to buzz with worries, her shoulders and neck are filled with tension and she often complains of being unable to relax. I begin to assess Karen’s attitude to herself. While Karen speaks I begin to notice how Karen thinks about and views herself. Is she proud of her life and work? Is she happy with her daily performance? Is she satisfied with her achievements? Basically, does Karen like Karen?
Fairly quickly the reality begins to show and we both recognise that Karen is fairly critical of herself. She often judges her decisions, doubts herself and overall is never satisfied with her own achievements. When I question her in details, she is unable to put a finger on it and explain what exactly she is unhappy about. I question her some more and Karen eventually says that her achievements do not really matter. Whatever she does, she will always be dissatisfied with herself. She will always look for mistakes. She will always look for “Just not good enough” conclusion after putting many efforts into something. Now the picture is clearer and Karen is stunned with what she is discovering. Hearing herself speak about this all, she is surprised to discover she fundamentally dislikes herself and judges everything she does all the time.
I ask Karen when and how she learned to treat herself so badly. This is when childhood trauma story begins to unfold. Ultimately, no matter how much abuse or neglect trauma survivors may have been though, the main damage is done not to our bodies or memories, it is done to our relationship with ourselves and our views of selves.
I am often asked about my “approach” to working with trauma survivors. Many people try to understand how exactly a clinician can access and treat childhood trauma in therapy. What should be paid attention to and what should be addressed? As years of my work with childhood trauma survivors go by, I tend to narrow the focus in therapy towards relationship with self, as it has become apparent that childhood trauma damages our relationship with ourselves.
Besides the stories of abuse or neglect in childhood I pay main attention to the relational trauma that occurs in the client’s childhood. What relationship did the client have with their caregiver (often mother, or father) and how their caregiver related to them. I am looking for the keys to identify and get a picture of what it was like to grow up within the particular household and how the client was seen by her or his caregivers? What was mum’s or dad’s attitude towards the client?
How our caregivers relate to us in childhood is important, because we when we grow up, we are likely to treat ourselves in the same manner.
Alex, 44, comes to therapy stating that he is “absolutely fine” and he is just a “worried well” who thought it might be a “good idea” to talk to someone. As we continue our sessions, Alex’s distress becomes more apparent. He is dissatisfied with his job, his partner, his “frustrating and meaningless” life, but as he tells a story after story, he makes comments like: “I am probably just rambling”, “I am really fine, I shouldn’t be here”, “I am probably complaining too much”. As I am hearing Alex dismissing his own concerns, I wonder whether he often neglects his own needs, and does not take himself seriously. It is not surprising that when we explore his relationship with his mother back when he was little, it becomes apparent that Alex was neglected a lot. He was often told to “man up” and not complain, be quiet and not to make noise. Alex grew up trying to occupy as little space as possible and ask from people or from life as little as possible.
There is not much point in developing self-care strategies, if deep down inside we believe we are not worthy of extra time, care, money or attention.
People may go through the motions of a healthy lifestyle, but if psychologically they do not like or respect themselves, it will be slowly destroying their mental health. Self-worth, self-respect and self-appreciation are key ingredients for mental (and often physical) wellbeing. When childhood trauma survivors understand that, we can begin our work on cultivating a better relationship to one self. Childhood trauma often leaves messages deep within us that we are “not worthy” or “asking too much” or “should keep quiet”. We need to identify these messages and confront them. Just because your caregivers in childhood did not provide a sense that you are “valuable” and “precious” and “deserving the best” or “as much as you want” care and attention and love, does not mean that the cycle should be perpetrated in your adult life.
In order to break this cycle, you need to learn how to be a better parent to yourself. Better than your actual parents. Learn how to praise and support yourself, learn how to refrain for criticism and ridicule, learn how to take yourself seriously and respect your needs and wishes. All these will be practices learned in adulthood, as you may not have been a lucky child born into a loving home, or you may not have had a nurturing mother, thus you did not have a chance to internalise these attitudes in your earlier years. It is never too late to start to treat yourself well and reap the benefits of happiness and joy it brings.
PTSD treatment 