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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5133
Experience:  Dr. Mark is a PhD in psychology in private practice
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Im in grad school, struggling to work, take care of my family

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I'm in grad school, struggling to work, take care of my family and get my work done. I have until 2012 if all goes well...I am weary, what can I do to take better care of myself.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Dr. Olsen replied 4 years ago.
Hello. Welcome to JustAnswer. I am sorry to hear your situation. It sounds you are under enormous stress. Let me ask you a few questions before I offer an answer. Is it possible for you to reduce any workload in any way? Are you physically emotionally fine now?
Customer: replied 4 years ago.
It is not possible to cut back any further at work, I already have to 24 hrs a week, plus 8 hrs clinicals, and six hours of class. I am low on energy and having problems meeting all my responsibilities, esp preparing for tests because besides the above hours I have six hours in class. I keep trying to take care of myself. My husband says he will make sandwiches the night before (2 in college, 1 freshman) :) but I cry sometimes because I miss being in the family.
Customer: replied 4 years ago.
I would like a refund. I sent the message much earlier and recieved no response. Please refund my money asap. Thanks.
Expert:  Dr. Olsen replied 4 years ago.
Hi there, thanks for waiting for a while. This is a challenging situation. Perhaps, all you can do is TIME MANAGEMENT to create more time for yourself and with your family. We all have the same hours - 24 hours a day. You may have to keep track of what you are doing every 30 minutes all day every day for 1 week to see if you can find waste time for YOUR TIME. For example, you may need to stop some habits like checking emails three times a day to once a day. No TV. No chat with friends. Delegate tasks to your husband and kids. Other things are like prioritizing your tasks, earning to say no, work on only necessary tasks etc. That may help you find extra 1 hour a day to send with your family.
identify bad habits and eliminate them etc. You may also talk to a counselor regarding your stress weekly or bi-weekly.
Customer: replied 4 years ago.

I think you have a point. thanks. If my family is my priority, then the places I lose my focus and waste time need to be more productive and life giving. Sorry, I wasn't sure this was legit or if I would get ripped off somehow. It might be helpful to talk about the stress's that come up...

Expert:  Dr. Mark replied 4 years ago.
Hi! Dr. Olsen has left the question, and I'll be taking over. I have read your question and replies very carefully and I believe I can be of help with this issue.

First, I want to say I can imagine how worrisome and scary your situation is for you until you graduate. At the end of my answer I'm going to add a technique I want you to use for helping yourself with the stress.

The key to what you MUST do to get through this is in the date you gave in your first question posting: you know that you have to maintain this schedule for about one and a half to two years. Okay, that's our starting point. It sounds as though your husband is supportive. Good. So, the first thing I want you to do is to make a big calendar of the time left till you're done with school with the milestones that will occur. There has to be a milestone at least every 2-3 months marked off on the calendar. I don't care if the milestone is that this quarter or semester is half over. It has to be a milestone that can be "X"ed off. And this X-ing off has to be a celebratory event for the whole family. I would like to see the extended family even involved, if possible. But certainly the inner family. If it means your husband takes you out for an evening out that night or pizza for the whole gang, whatever, it must be noted that you've just passed another milestone in this marathon! This is number one: you have to have goals that are smaller than just your big overpowering goal because it's too big and too far away.

Okay, then I need you to reorient your view of what vacations are and what counts as relaxations:

You know how people come back from vacations and say "I need a vacation to recover from my vacation!" Why? Because they did a lot of activities but they never really connected with THEMSELVES during their vacation! What makes a vacation great is when you reconnect with yourself or with someone special in your life. So, you have to focus on two things:

1. You need to read my answer to your husband and discuss it together. You need to reconnect with each other. That means in two ways: he needs to take you out of your focus for a five minute connection break, not out to dinner for a whole evening, but for a 5 minute walk around the block, or a 5 minute dance to an old song you both like, or aXXXXXto Starbucks to get some coffee. He needs to listen without offering any solutions. NO SOLUTIONS. Just, how are you doing. He needs to read this so I can assure him, you will love him more than ever if he does this! Second, once a week he's got to do something with you that is longer than the 5 minutes. I don't care if it's sitting INSIDE the Starbucks and having a real conversation about what his dreams and life is like as well as your life, or if it's a romantic night, or renting a video and sitting in each others arms. Get the idea? I don't think time management is your problem, so I'm not even mentioning it. I think "self" management is the problem!

2. Your SELF! Remember: you can have a 2-week vacation and what will make it memorable might be a 2 hour event or new awareness you came up with. Well, you need to get back to your self every single day. I'm not talking about meditating for half an hour (yet...) because you will see that if you set your alarm on your phone for an hour into your studies or housework or whatever and take 5 minutes to just sit with no radio, TV, or computer and just breathe and think about your self, you will start looking forward to your "breaks"! Once every third day I need you to start learning how to meditate! That's right. You need to start taking what you said as a real, true insight into yourself: you knew in your first posting that you NEED to take better care of yourself. But it isn't your body you need to worry about here. It's your SELF that needs attention! So, don't laugh it off. Here is a great book to learn from. I'm a psychologist in private practice and this author is a psychologist who has done more to bring meditation into mainstream psychology than any other professional. So, start with this book:

Wherever You Go There You Are by Jon Kabat-Zinn. (Great title isn't it?) It's a classic book and you can get used copies cheaply. Here's the Amazon web page for it:

http://www.amazon.com/Wherever-You-There-Are-ROUGH/dp/1401307787/ref=sr_1_1?s=books&ie=UTF8&qid=1286083972&sr=1-1

Okay. So again, let me stress that the problem is not time management, it's allowing your SELF not to be swallowed up by how well you're managing your time to get things ACCOMPLISHED but not to NURTURE your self.

We're now ready for the technique I want you to use when you are feeling stressed. At first you can even use this to get your 5 minute breaks started. You can teach it to your husband! It talks about anxiety and panic attacks, but don't let that throw you off: stress is what anxiety is made of at first. So, enjoy the benefits of this technique:

Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks and for feeling as though you are in a dark hole of depression as well.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in a panic attack is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class for seniors and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5133
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
I did much of this, but still working on the calender. I am struggling, still. In a week I will be done with clinicals, so that will give me an extra day. But, I notice I am no longer keeping up with the house and resist leaving the house, unless its for coffee or to drive my child somewhere. I feel like I'm lost; detached. I don't want to forfeit all I worked for and don't plan to. The smaller self care things arn't working. My self wants to be at home. I'm upset inside. Its painful to be seperated from my family and caring for others, only to return so depleted I am despondent inside. Its like I'm idling, but not going anywhere or reacting to my enviorment...but not getting refueled.
Expert:  Dr. Mark replied 3 years ago.

Hi! In one sense it's nice to hear from you because I rarely get to hear again from people in this forum but it's also difficult I know for you because it is now clear that your problems are getting more pronounced and not responding to self help.

And this is actually the key to my answer to your current question that you need to consider and think about and talk with your husband about.

It is time now for you to seriously consider getting help professionally. There are two approaches to this, one is psychiatric and the other psychological. I usually propose the psychological first so the person can explore the human aspects of what is going on within them and then decide about medications from that perspective of already working on their psychological self.

In your situation, where you have a timeline that is definite, we may wish to reverse that and focus first on the psychiatric aspects: getting medication to help you cope with the stress and depression of the demands on you. I don't know your stance on medications; some people are against them because antidepressants are so commonly prescribed now that your doctor probably won't be willing to even give you a referral but will prescribe them him/herself. There is the risk of not having your reactions to them monitored well and so you will need to be proactive in asking lots of questions to your doctor about what to expect, when to call if you feel any reactions you don't like, things like that. The other danger is that you can begin to get used to them and find yourself 15 years later still taking them. Some people don't mind and some people are afraid of this.

So, depending on your attitude to antidepressants I would start with the visit to the doctor and see if the medication gives you the boost you need to not be feeling like you're idling. It very well might.

Or you can decide that you want to combine the medications with therapy. If so, let me give you a couple of resources. I have found that with your situation you will do better with a more introspective, humanistic approach in therapy along with Cognitive Behavioral Therapy. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades. I would like you to interview psychologists who use both a CBT and a humanistic focus. For example, one therapy that might be very useful to you:

The therapy is called Focusing. It was founded by a great psychologist named Eugene Gendlin. I use these techniques in my practice often. Here is the link to the Focusing Institute:

http://www.focusing.org/

They have a list of certified therapists and you may find one in your area. See if the therapist also uses a CBT style therapy as well.

 

Here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list humanistic therapy as well as CBT in their orientations.

http://therapists.psychologytoday.com/rms/

The idea here isn't that these two types of therapy are magic. It's that I want you to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions as well as give you tools and work on skills.

So, I think these are the choices for you to make in consultation with your husband. I know you wanted to do this on your own but I would very much like you now that you've seen it is progressively becoming more serious to make the choices I've outlined above.

Okay, I wish you the very, very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

 

Customer: replied 3 years ago.
I feel it was very unfair for me to seek some help for this in my last question. I am in grad school to be a psych NP. I am reading Bowlby. I get all this. I am safe. Your advice is warranted, albeit not where I am. I did a great deal of introspective work and am moving on. It is difficult, though. I love my husband, but I do not get the energy and perspective I did when working on some recovery issues. I'm lonely. I have the tools, faith, and support. It's just I'm grieving not having anyone that get's me. There I said it. One thing that helped me on the way home from my son's football game tonite, was telling myself "I've never been Here before." It feels like I have because in some ways I have, but really I haven't. It's been a long long road, but my goals are bigger than school. I get something out of talking. My question is how do I get that more informally, like this rather than see a therapist? Maybe its intellectual stimulation or just the energy of being seperate from the deamands. I do need a physical before I drop my double coverage for insurance, but last year all was great. I could do that, but I'm looking for something that I can look forward to, like this response...why that helps I lack insight into, but not another place to be. Lastly, I have dogs; labradors. I have been thinking of building some stairs up to a study I build off the back of our Master Bedroom so they can come up and see me. Could you help me be accountable with a project like that? Or is that unrealistic given this format? Sorry, for the long answer.
Expert:  Dr. Mark replied 3 years ago.
Hi! I'm not sure either if this question/answer forum is comprehensive enough.

Let me see if I can explore two things. You opened a whole discussion that we might have to save for a real therapy session about your husband not getting you. Hmm... You're trying to communicate something that I'm not sure you're even sure you're ready to open up completely yet.

And I'm not sure if this question of the stairs to the study is involved in this or not. There's a certain symbolic aspect to this desire to build stairs to your study off the bedroom so they can come up and see you. There's some intimacy here that you're seeking that they're safe to get it from...

Again, this may be the wrong format as you say and I also don't know what you mean by being accountable. So you need to decide how you want to pursue the direction I've taken this in.

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5133
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you

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