Podcast: Play in new window | Download | Embed

Subscribe: Apple Podcasts | Android | RSS

Hello, friends! It’s very very hot over here this week, but I still decided to lock myself in my office without a fan and record this Q&A episode! There are three really great (and different) questions that listeners sent in, and I try my best to give some helpful advice.

My question is around a sister in law (SIL) who decides she knows why I do the things that I do. Even when I explain otherwise, she continues to hold her original opinion. There are dozens of examples. The most difficult one is one that started from 2 years ago.

I am a recovering alcoholic. my last drink was 2 years ago. My SIL decided I choose drink because I don’t care about how I affect others when drunk and I am not really an alcoholic.

I try to explain to her I’ve been drugged and abused since I was an infant. This trauma was not a choice and addiction was how I survived as a child. It takes serious work to undo the fucked up survival skills. She seems receptive and visibly softens after my explanation, but the next time I see her (couple days later) she back at telling me I don’t care how I hurt her family.

She isn’t someone I can avoid, and for the family business we have to spend a lot of one on one time together. The past year of regularly changing the topic is exhausting. And we don’t talk anymore about the things we both enjoy.

Do you have thoughts as to how I might address this. Making the truth of my addiction stick with her?

Thank you for the question. Congratulations on maintaining your sobriety and making positive changes for yourself. I’m sorry that your sister in law is not taking you seriously and is treating you the way that she is. It’s even more impressive that you have been able to stay sober with that kind of negativity around you.

Here’s the thing –  you may not be able to make the point stick for her. I’m not sure why she always reverts back to the type of behavior and judgment that you are describing. It may be true that your actions in the past have been harmful to her or her family, but I imagine you have tried to make amends and move forward from that. If you haven’t, maybe that would be an important step here. To hear her out about the way that she feels you have affected her and give her a legitimate apology for the hurt that she feels with the acknowledgment that this is for the purpose of moving forward.

You can’t change the past, only look to the future

You may need to come to some agreement to draw a line in the sand. You can’t ever make things better if you don’t let the past be in the past. I have a chapter on emotional bankruptcy in my F**k Depression book that I think would be relevant here. I use the term differently and refer to emotional bankruptcy in a similar way to financial bankruptcy. You accept that you can’t reasonably pay back the debt, but are prepared to take a hit to your credit rating etc. in order to wipe the slate clean and start afresh. Similarly, you can do this with your emotions where you admit that you can’t change what has happened, but also can’t do anything positive if you don’t allow yourself to move forward. By doing this you aren’t avoiding responsibility, but accepting responsibility and leaving it in the past so you can positively move forward.

If that doesn’t work, there must be something else going on here. Maybe she has no way to empathize with what you are going through or maybe it’s important for her identity and the life that she has built to make you out to be the villain. Some people have a situation that is like a delicate house of cards and they fear any person changing roles or identities because that means the whole thing is at risk of crashing down.

One thing you may not have considered is bringing this discussion into the therapy room. I think that having a facilitated discussion about this with a family therapist could be really productive. If not with a licensed professional, maybe you have an AA sponsor or another person like that who could serve as a sort of mediator. The point is you may want someone to keep things civil and balanced. It gives each of you a chance to say your piece without getting nasty.

Boundaries are vital

You are also allowed to have boundaries in this situation. In fact, I would go as far as to say that they are vital here. Working with family can be really difficult because the lines between coworker, friend, and family get blurry. Maybe you need to have a verbal or even written agreement that certain topics must be off the table when you walk through the door of your workplace. You can also make plainly clear to her what you are and are not willing to tolerate. For instance, maybe it is okay for her to ask how you are doing or talk about the topic of your sobriety, but she is not allowed to get mad at you for things that you no longer have any control over. If she is going to provide feedback, it has to be related to what you can do moving forward.

For some couples in romantic relationships, it can be helpful to develop a sort of strategy and routine for having these conversations. Maybe you start with the agreement that you are family and love each other regardless of how the following conversation goes and that you will both attempt to not take things too personally. Then you start with something that you are proud of each other for and something that you would like to see more of. Just some sort of structure.

Part of the work for you might also be changing your expectation of the type of relationship that you are going to have with your sister in law. It can be annoying to talk about surface level things instead of real topics, but maybe this is someone that at this point in time you are simply not going to be close with because of the history that you have together. There is really no right answer here, but you might just need to step back and reassess your relationship expectations.

Challenge your expectations and assumptions

Again family business is tough. I always caution people to be very sure that they know what they are getting themselves into because it is often a source of conflict among family members. You likely won’t agree on everything related to the business, you have to count on one another to hold up your side of the work, and you are also probably forced to be in close proximity more often, which will increase the chances of conflict.

So in addition to these other tips, you may want to consider whether it is a good idea for you in the long-game of your sobriety and recovery from trauma to be a part of the business. This is obviously a big question that I wouldn’t expect you to have the answer to right now. In fact, that is a discussion that you should probably be having with a therapist, but it’s important to challenge the assumption that things have to stay the way that they are. Especially if that is making you work an uphill battle for your own mental health when things might be a lot smoother if you were doing something else.

I hope that these tips are helpful to you. There are some things that you can try to help the situation, but you have to keep in mind that there are two people in this family relationship and you can’t force someone else to change. But maybe you could try to enact some of these strategies that we talked about and then if nothing changes, take a harder line on your boundaries and wait for a time in the future when she might be more receptive to change.

Overall, I think you are doing a great job. You seem to have a good handle on yourself and I like how you acknowledge that the problematic coping strategies that you have employed in the past served the function of keeping you safe at the time. That is always important to recognize. They are not sustainable and you don’t want them anymore, but those behaviors did have a purpose.

I think you are on a great path toward having a life that is safer and more satisfying for you and I just want to congratulate you on that.

You have such good practical advice about time management on the show and I’ve loved your “how do i get so much done’ podcasts, so this is in the same vein.

As an ADD person, I am not very good at knowing what’s next. I notice that some of my friends are able to mentally plan their next few hours/afternoon/evening. I don’t have that skill and would like to get more fluent with that.

I’m a bit better at planning on paper, but if something even small unexpectedly changes my schedule, I have a really hard time with that, whereas I notice that it doesn’t seem to be as big of a deal for others. How do I learn this skill and get into the habit of mentally planning?

Good question. I’ve actually had several similar questions about sticking with a routine, getting things done, and executive functioning.

A couple relevant episodes if you haven’t listened yet. In episode 151, I talk about my best productivity tips and in episode 32, I talk all about ADHD – so some of this might be review.

ADHD refers to attention-deficit/hyperactivity disorder. You can have inattentive type (trouble focusing/paying attention), hyperactive type (behavioral problems, impulsive), or combined type. It’s typically understood as a childhood disorder. Many people grow out of it, but not everyone. There also may be an adult-onset version, but this is debated. Other issues like stress, anxiety, mild brain injuries like concussions, etc. can also cause similar symptoms.

The thing about ADHD is not that you have no attention span, it’s that you have a hard time pointing your attention in the right place on command. You may be able to hyperfocus on certain things that are interesting to you, but something as simple as reading an email can be super hard because you keep getting distracted by things on your desk, notifications on your phone, and just about everything other than the email. You might find that you read the email and then realize that you didn’t internalize any of it, which causes you to read it again.

People with ADHD also tend to have some difficulties with what is called executive functioning. Executive functioning basically refers to the functions that come from the frontal lobes of your brain. They are the higher-level skills that you might use in a workplace like multitasking, filtering out distractions, and planning your approach to a task. It sounds like this is one of your sticking points.

Practice and planning

One thing that you have already done really well here is to try to adapt to the situation. You can definitely get practice and work on training yourself to function better, but half the battle is also adapting to the situation given your particular style. I think it may not be reasonable to expect yourself to have this fully integrated awareness about timing, planning each move in advance etc. Instead, we just want to expand on what you are already doing with the “planning on paper”. The problem that you are having is with mental flexibility. When you are interrupted or when something changes, you have a hard time staying on track or getting back to the task at hand.

I think that mindfulness is a helpful practice that can help you develop better mental flexibility. But aside from this, it’s about planning ahead and catching yourself when you are being pulled away from the task at hand. You can also develop a strategy for getting back on track.

I am a big fan of planning my day the night before or in the morning when I’m having coffee. Personally, I enjoy doing this old school on paper. I have a Google Keep that I use to keep my master list of important tasks, but at night or at the beginning of the day, I simply pull out a sheet of notebook paper and keep that in my pocket all day. This is for two reasons – one is that I always have it on hand so I can write down stray thoughts like “get back to John” or “pick up diapers”.  The second reason is that I can reference it quickly and there are less distractions along the way. Sometimes when I go to open my phone to look at a to-do list, I get distracted by social media or email along the way and then lose my train of thought. Then you might lose what you were thinking or find it hard to get back on track.

If I were you, I would do two things with the list. I would write a list of all the things that you need to remember or get done the next day on one side. For me, this is usually a bullet point list on the right side. Then you use the other side of the page to outline the day. Go as detailed as you need to. If 30 minute increments is just too much for you, then be looser with it. I tend to do it in chunks like before taking the kid to school, during the little one’s nap, once I get to the office, etc. This way you can have an idea of what you need to do during your day and then when you hit a roadblock, get sidetracked etc, you can catch yourself and look to your list of other tasks to get back on track.

Rather than trying to figure out what the perfect thing is to do, just pick a task at random and get started. If you have a clear priority task then do that, otherwise, don’t waste time overthinking it. If you get started on something and realize that there was something else that you should have done, just switch to that other task. There isn’t as much risk as we think.

Take a break

You also may need to schedule in breaks to think about what’s going on. A lot of times, we just go from task to task without giving ourselves a second to pause. So for you, making sure you have 2-3 moments where you sit down with your list, think about how the day has been going so far, and adjust if necessary, would be really helpful. This should be without other distractions. Just sit, consider your day, think about what is next, do a little planning if necessary, and then get back to it.

Again, I want to caution you against falling in the trap of trying to hard to make sure you prioritize the right way. If you waste time trying to make sure you do the perfect thing, then you will end up doing nothing. And when you have an unexpected change in your day, take one of those pauses and reconfigure things in whatever way you need to before you go into the next activity.

As I mention in my productivity episode (151), I’m also a big fan of leaving myself an outline or the next step if I need to abandon a task and come back to it later. So before you leave the task at hand that you have to abandon, write a few notes, bullet points or outline your next steps so that when you come back to the task, you can jump straight back into it from where you left off.

Hopefully these tips are helpful to you. Aside from this, the only other thing to work on is if you tend to get down on yourself or beat yourself up for getting off task in the first place. It’s okay to struggle and have to do things a different way. And you don’t have to be the absolute most productive person in the world. A few small tweaks might make things run a little more smoothly for you.

Thank you so much for creating such a great mental health podcast. It is one of my favorites. I struggle with complex PTSD due to growing up under chronic stress and emotional abuse. Those situations caused me to develop chronic symptoms of dissociation and depersonalization as early as the age of seven. This is very different from DID as I am still logically aware of who I am, my brain just creates this detachment from my physical body as if I am watching myself live my life from the outside.

In February I got hit with a total PTSD breakdown and am still in the midst of it. Things like the sound of my voice, or looking in a mirror, are major triggers for me. I’m also having a very hard time leaving the house. I keep trying to push myself to go out and to speak verbally, thinking that if I don’t give in to the anxiety then it will lighten up. But I’m not seeing much improvement. I am actively in therapy several days a week and still meeting up with friends as much as I can, but my degree of suffering is unwavering. The people I am spending time with are so supportive and know about my symptoms. I’m just at a loss for how to gain control over this. I’ve had these symptoms all my life but never to this degree.

Depersonalization in particular is rarely talked about and I was hoping to gain some knowledge on your perspective of this. I cannot ever remember feeling fully attached to myself. It makes traditional anxiety coping skills such as mindfulness and meditation particularly difficult. I would love to hear your thoughts on this matter. Also, do you recognize Depersonalization/Derealization as a disorder? It is relatively controversial. Thank you so much!

Thanks for the raw and vulnerable question. Let’s talk about a few of the terms here. PTSD is posttraumatic stress disorder and involves symptoms like hypervigilance, flashbacks, emotional instability, and strong reactions to triggers that are caused by a past trauma. DID is dissociative identity disorder. This is when you have multiple personalities that exist within the same person referred to as alters. You literally take on the persona of a different person. This is not what the question asker is talking about.

Depersonalization and derealization refer to the feeling of being detached from your body or your surroundings. Often the feeling is that you are outside of your body and watching from a third person perspective. You kind of go on autopilot. You can function relatively normally, but you are in this fog and not connected to anything that’s happening around you. In small doses, it might be an interesting sensation, but for people that experience it a lot, it can be very frustrating and uncomfortable.

The common understanding is that it sometimes develops as a reaction to trauma because your mind knows that it simply can’t integrate the terrible shit that you are going through, so it basically checks out and disconnects. So for the person asking the question, I’m sorry that you are going through such a hard time. When I got this message it was in May, so the current bout of increased symptoms had been going on for a few months already. That’s really tough.

The right exposure

During that time you said that you are not seeing much improvement despite doing a lot of things right. You have been trying to avoid avoidance and approach the things that make you feel anxious or disconnected, which is great. That’s a process that we refer to as exposure. You are also in therapy and have a good support system. All helpful things. But after a few months, these symptoms are not budging. I think you are right to wonder whether there is some change in the approach that needs to happen.

The caveat here is that if you are in the midst of whatever triggered you still, it is reasonable that you haven’t seen much improvement because it’s ongoing. So if it’s something that’s ongoing, you need to give yourself some slack for that. But if it’s not, then we just want to look at things we can do to tweak the situation and help you move forward.

Overall, I think you are doing a great job and I have just a few things for you to consider. If you haven’t yet, definitely check out episode 98 about exposure and/or my Kick Anxiety’s Ass course. Exposure work is something that even a lot of therapists don’t know how to do correctly. It could be that your approach to pushing yourself to continue engaging could just use a little tweaking. You mentioned that mirrors, the sound of your own voice, and things like that serve as triggers for you. This is relatively common and some people use those as an exposure method or a means to practice their grounding exercises.

Grounding exercises are probably something that you have been over with your therapist, but they are strategies to help you try to reconnect to reality when you are feeling dissociated or depersonalized. A basic one is what I call “sensory bingo” where you go through and find something for each of your senses to connect to. You could repeatedly get practice at triggering yourself using one of your methods and then try to work your way back to the present moment. This would both help you recognize that there is nothing inherently dangerous about being disconnected and give you practice at pulling yourself back in when you need to.

While I am obviously not a fan of letting anxiety limit you, it could be that you are pushing too hard to keep everything the same and keep engaging in your social activities etc. Maybe you need to take a step back and work with your therapist to develop a gradual exposure process to get back to what you would consider more “normal life”. Regarding your therapist, it’s also important to consider whether you are benefiting from sessions. You are doing a great thing by staying in treatment, but if you find that your therapist isn’t doing the trick for you, maybe there is a change that is called for. There is nothing wrong with you if you need to do that. Perhaps there is someone who is more of a specialist in your area that you could try.

Things to consider

Overall, I just wonder if there are some changes that could be tried out. Maybe it’s just one puzzle piece that needs to be shifted to ease things up a bit for you. It’s hard to know exactly what that is but I have a few more suggestions.

Are you on medications? If not, this might definitely be something to consider. Talking with a psychiatrist and determining if medications would be appropriate is definitely something I would suggest if you haven’t yet. To me, when your symptoms are preventing you from doing the things that would help you get rid of your symptoms, that’s really where medication is the most useful. If you can just reduce the overall level of symptoms that you are feeling, you might be able to get more benefit out of all the things that you are already doing so well.

Likewise, if you have tried just about everything in terms of medication, intensive treatment, etc. perhaps it is time to consider one of the options for treatment-resistant anxiety. In particular, Ketamine seems to be effective for people with a history of trauma. There is the new Spravato esketamine nasal spray that was recently FDA approved and you can also do ketamine infusion therapy, which I cover in episodes 137 and 138.

There are also your life circumstances to consider. Again, throughout all of this, I want you to remember that you are doing a good job and doing many things right, which makes me think of other factors outside of your own efforts. Is there something in your environment or your day to day life that is creating such an uphill battle for you right now? For instance, a job, living with family, or the city that you live in could serve as stressors or triggers that keep you in a constant state of anxiety, which is why your body keeps flipping into depersonalization mode. If this is the case, it could be time to consider a structural change to your life for the good of your mental health.

Focus on the facts

I also want to encourage you to go easy on yourself for having the symptoms in the first place. I know that it is uncomfortable to feel dissociated and you are allowed to not like it. However, I want you to also look at the facts of the situation. A lot of people fall into the trap of emotional reasoning, which is when you assume that the way you feel is fact. In a situation like yours it may be that since you feel so icky and disconnected, you assume that you are doing things the “wrong way” in your daily life when in reality, if you look at it on paper, you may not actually be screwing anything up. You’re just having a really bad internal experience. So everything might in fact be fine externally, but you don’t feel like it because of this internal experience your having. It’s important to have both – you’re allowed to feel bad, but also look at the facts of the situation and try to see if you can logically recognize that you’re not screwing things up.

My old supervisor used to use the term “Let your robot do the job.” Which basically refers to your brain’s ability to go on autopilot and get through the day even when you don’t want to or feel disconnected. Sometimes it’s okay to let your robot do the job – that’s just you getting through when you need to get through.

Another factor to consider is your medical health. Are there physiological factors that could be at play here? There are too many possibilities to list, but thyroid issues, migraine headaches, autoimmune conditions, vitamin deficiencies, etc. can all contribute to anxiety, mental fogginess, or dissociation. Get checked out by your doctor and push for more diagnostics if you think that there are still things to rule out. Sleep patterns are also important to take a look at.

Change your focus

I often talk about focusing too much on the problem in my answers on this show. Same thing here. You might try loosening your focus on the problem itself and instead work on finding ways to get busy and engrossed in something else. Are there any activities that make you feel very present and give you a flow state? Like for me, this might be competitive gaming or training martial arts. Whatever it is for you, giving yourself the chance to be engrossed in these activities more may help out.

As to your other question about whether I see depersonalization-derealization as a real disorder – the answer is yes. However, it is poorly understood. Perhaps it is just a subset of anxiety disorders or it has a different origin. I don’t know. What I do know is that there are people that have these symptoms as a central part of their experience and they deserve consideration.

I hope you find a little relief soon and that this answer gives you some ideas of places to consider tweaking your approach.

SPONSOR:

This episode of Hardcore Self Help is sponsored by Openfit and Green Chef.

Openfit is a new digital streaming platform that integrates fitness, nutrition, and wellness together in one place. Both convenient and personalized, Openfit offers customized plans to suit your needs. Right now get your Openfit 30-day free trial by texting “DUFF” to 303030.

Green Chef is a USDA-certified organic company that makes eating well easy and affordable, with a choice of meal plans shipped direct to your door. Head to greenchef.us/duff75 right now for $25 off each of your first three boxes!

Thanks for listening!

Interested in having Duff answer a question on the podcast? Email Duff at robert@duffthepsych.com and maybe you’ll hear it on a future episode!

Want to help out the show and Duff the Psych?

• Subscribe to the podcast on iTunes.
• Leave a podcast review on iTunes. These reviews really help Duff reach potential listeners, and he appreciates every one!
• Share the show on Facebook or Twitter.
• You can also buy Duff a cup of coffee, which helps fuel the energy that goes straight back into creating more content for YOU!