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Do You Practice What You Preach During Holiday Time?

A week ago, I was scrambling around late Sunday afternoon wondering, “How will I get it all done?” I was trying to get ready for my Monday/Tuesday out-of-town clinical job, get a Christmas tree (I had just been told, “They’re going fast”), redeem a terrific about-to-expire coupon at Kohl’s; work out at the gym, and then head home to make and host our weekly family dinner – an important tradition with our young adult kids.

My heart was going full-speed in panic mode until it occurred to me to put into practice the very skills we use with our clients at a holistic outpatient substance use/co-occurring disorder clinic: focus on diaphragmatic breathing, mindfulness, and cognitive restructuring. So as I started my breathing, I reflected on whether I’d benefit more or less from going to the “Y.” Something had to give, and so I decided that as an avid exerciser, missing a day was no big deal. I felt relieved and a lovely dinner was served almost on time.

It got me wondering about how often we practice what we preach to clients as well as how they and their families can benefit from what we know – particularly at this time of year. So I solicited clinicians for their thoughts, adding some of my own, and came up with the following.

Set Boundaries

This strategy came out on top, recommended for both clients and clinicians.

Give yourself and your clients ‘permission’ to not attend family gatherings at the holidays.

In short, one therapist said, setting boundaries means, “(1) learning to say ‘no’ without feeling guilty, thereby not fueling resentment or feelings of being overwhelmed and (2) carving out time for self-care during all the rush, whether it’s a walk around the block at night stargazing, listening to soothing music, or getting a massage.” Another advised, “Give yourself and your clients ‘permission’ to not attend family gatherings at the holidays.” She talked about helping clients set boundaries with difficult family members – if they repeatedly cause stress and trouble, you don’t have to invite them or they can be invited to a separate event.

Another said, “My clients and I discuss emotional boundaries, not taking things personally that happen at family gatherings, and doing self-talk to get themselves through.” Blended families (as a result of divorces and new marriages) don’t have to come together if there are personality conflicts.

When it comes to clinician boundary-setting, someone who has a busy work schedule and loads of activities with her young children said she’s setting some limits with an emotionally needy friend who constantly needs support.

We can’t abandon the client, yet staying engaged with those who need us will burn us out and thrash our boundaries…

Another shared that at the end of a long day, a client revealed that she not only had a serious, secret alcohol use disorder but a three-decade long secret eating disorder. The counselor started the process of getting her help but admitted, “I was a weary therapist needing to go Christmas shopping and home. Holidays make it extra inconvenient to address urgent clinical issues and provide ongoing care as clinics close down and therapists seek to have a little time off. There are no easy answers. We can’t abandon the client, yet staying engaged with those who need us will burn us out and thrash our boundaries… We need to assert boundaries, allow / encourage patients to help themselves, and ask for help and backup. It’s important for us to take time off and not say ‘yes’ to every client need. And staff should be encouraged to check in more with one another.”

Plan Ahead for “The Alcohol Issue”

Clients in RehabWhat about people who are in residential treatment at holiday time? While some are lonely and wish to be with family, “other residents are happy to be shielded from family,” said Tom Horvath, Ph.D., president of Practical Recovery, which has both outpatient and residential facilities.

(Sometimes families want to be shielded from the person who is in treatment, at least for a while.)

At their residential facilities, clients are often granted a therapeutic pass for a short time. And in the clients’ individual sessions with therapists, “Significant preparation occurs about how to cope with whatever problems seem likely to occur.” For those who remain at the facility, Practical Recovery offers a big family meal, sometimes with family or other guests. (And Dr. Horvath personally will be there.) They had 30 attendees for Thanksgiving. Certainly, if you or your loved one will be in rehab over the holidays, this is something to ask about ahead of time.

This can certainly be important for both clients and recovered clinicians. “Probably the most common and simple issue I address with clients is the amount of alcohol that is usually consumed at family gatherings over the holidays,” said one therapist. She added, “We talk about how to communicate concerns with family prior to the day, as well as their plan to address this if it is difficult. I always encourage people to have their own transportation so if needed they can leave the situation and to have a sober ‘buddy’ along if there is no alliance with a family member who is attending.”

Another counselor shared, “Both from a personal and a professional perspective, I have found it useful to have a plan not only having to do with use of alcohol but having to do with how long one will stay at an event, what subjects one will agree to discuss [or not discuss], and how cravings will be managed in the moment.”

Teach Clients Basic Counseling Skills

Let’s say you’re working with a family member who describes a newly sober spouse who’s been cranky and snappy. She’s concerned about his long history of getting depressed around the holidays, which in turn has led to binge drinking. Help the family member break old reactive patterns by using basic empathy skills – instead demonstrating that she “hears” him.

One therapist said she recently told a spouse, “When you name it, you tame it.” The spouse had shared that her husband said he felt bittersweet about all the lovely things she did at holiday time but it also made him feel bad that he never experienced that growing up. The wife simply said, “That’s sad,” which the therapist reinforced as a perfect response and stressed that it isn’t the wife’s responsibility to “fix” the husband’s feelings about his past. During times when he snaps at her, the counselor suggested saying something like, “You seem really stressed.” She said, “This validates his behavior and then opens the door for a request” (for instance, for a change in how the husband has been reacting to the wife).

Manage “Shoulds” and Traditions Differently

Take the case of holiday cards – who says they have to go out before the holidays? Since my husband and I always take off the week after Christmas, that’s when we put together the annual update and send our holiday greetings for the new year. Some of our long-distance friends send their greetings months after the holidays, and we’re happy to hear from them at any time. And many people are now sending greetings electronically – this saves time, money and is a sound environmental strategy.

Recognize Feelings of Loneliness, Use as Growth Opportunities

Clients (and sometimes clinicians) feel particularly alone and isolated at holiday time. I’ve seen this in a peer support group I facilitate as recently separated and divorce parents face the holidays alone for the first time and wonder whether they’d be better off alone or going to the home of a friend with family bustling that only reminds them of their loneliness. They obviously need help with a plan.

Such insights may lead to an intense alcohol binge or using higher doses of heroin or meth to numb the pain and thereby create a family crisis.

A clinician who works with a number of chronic homeless clients said, “They often have feelings of desperation during and around the holidays. The pain of isolation at this time can trigger memories as to what they have done to traumatize their loved ones so seriously that the families have walked away. Such insights may lead to an intense alcohol binge or using higher doses of heroin or meth to numb the pain and thereby create a family crisis. This brings the family running to their aid, but unfortunately I have seen many clients who had an apparent accidental or intentional suicide attempt during the holidays, and the family did not respond. As painful as it is, there is a golden opportunity for clients to look at their own responsibility for their current predicaments during the holidays. This could offer a very important opportunity for growth.”

What’s Your Mantra?

In closing, a clinician who works with adolescents offered the following mindfulness-type strategy: “I think developing a mantra, a phrase you can use over and over to bring about a state of mental calm can be helpful. For example, “I’m doing my best and my best is enough”; “I can handle whatever comes”; or “I breathe in peace and serenity.” She added, “The best mantra, of course, is the one you make up for yourself.”

Thanks to the following individuals for contributing: Tom Horvath, Ph.D., ABPP, President, Practical Recovery; Marlae Marlae Cox-Kolek, MS, LPCC, LADC, Mankato Mental Health Associates; Len Van Nostrand, MA, LMFT, Full Spectrum Recovery & Counseling; Christine Frances, MS, LMFT, LPCC, Sacred Circle Counseling; From Minnesota Alternatives (where I work part-time): Paula DeSanto MS, LSW, John Bollig, R.N., Kelley Murphy, BA, LADC, JD, Jill Sweeney, MSW, LICSW, Krissa Jackson, MA, CPRP.

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