Session Five: Self-care

Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

Session Goals

Explore the benefits of taking care of oneself.
Explore self-care strategies across all domains of participants’ lives (e.g., physical, emotional, social, spiritual, financial).
Encourage and help participants as they develop their own self-care plans.

Content Outline

Short-term self-care strategies.
Dealing with difficult feelings.
Long-term self-care goals.
Building a self-care plan.

Activities

5-1: Identifying the Quick Wins
5-2: Stop-Start-Continue
5-3: Self-Care Plan
5-4: Assessing Resilience

Leaders’ Notes

In our group about one third of the participants approached the whole idea of caring for themselves with great enthusiasm. They agreed that caring for oneself should be a priority for family members and they had already taken steps toward creating, regaining or maintaining their physical, emotional, social and spiritual health and well-being. They were eager to convince their peers that maintaining a healthy balance in their lives would help make their situation a little easier to bear. They talked about how attending to their own needs had positively affected their lives, and were eager to share the specifics of their personal self-care plans and activities. For example, one of the mothers in the group talked about how much she looked forward to walking long distances every day and reading inspiring books. Another participant discussed the significance of spirituality in her life and described how her spiritual beliefs had comforted her and helped her keep going despite feelings of loss, grief, sadness and self-doubt. Another participant described how connected she felt after attending family focused self-help / mutual aid groups.

However, if there is one topic with which many family members become frustrated and impatient, this is it. Some family members are not yet able to break free from the anxiety, preoccupation and stress inherent in caring for a loved one. We found that family members newer to the experience of caregiving were more cynical about spending an entire group session talking about the benefits of taking good care of themselves.

I know intellectually that I should be taking better care of myself, but realistically, where am I supposed to find the time? I’m dealing with one crisis after another. It sounds really nice and all, but I’m afraid that relaxing with a good book or dragging my husband out to see Brad Pitt and Angelina Jolie on the big screen just aren’t on the radar right now, you know? Spending time thinking about myself and worrying about whether I’m eating too many carbs or getting enough beauty sleep or working on those abs seems a little over the top, you know what I mean? They’re luxuries some of us just can’t afford—especially when your hypomanic 18-year-old kid has just been busted by undercover cops for buying drugs from the friendly neighbourhood crack dealer.

If you validate the exhaustion and stress that caregivers experience, you can ease into the topic of self-care without appearing to be insensitive. Most family members experience a kind of journey of recovery that often parallels the ups and downs that their loved ones experience. They may be unable to focus on their own self-care needs or they may wrestle with feelings of guilt and shame when they think about doing so. Many participants commented that they would start to relax and feel happier once their family member received proper treatment and started to get better.

Using a self-care activity

Beginning the group with a self-care activity just prior to the weekly check-in is an effective way to introduce the topic of caring for the caregiver. We used a meditative exercise from Full Catastrophe Living (Kabat-Zinn, 1990) in which raisins are used to facilitate the practice of mindfulness. Group participants were so delighted with this exercise that we ended up including it at the beginning of each of the remaining group sessions. You can also invite the participants to imagine that their past week was captured on tape. Ask them to review the tape from a self-care perspective. As they do this, can they identify a low point and a high point from the past week? Invite them to share a key point or two if they are comfortable doing so.

Using an analogy

Another way of introducing the participants to the idea of self-care in spite of—or perhaps because of—the challenges they face is to use a simple analogy to reinforce the fact that without their own physical, emotional, social and spiritual health, their attempts to help their ill family member would likely be ineffective. You can ask the group to respond to the following:

You are travelling by airplane with your three-year-old child when the plane suddenly loses cabin pressure and altitude. Oxygen masks drop down in front of you and the rest of the passengers. Who do you put the oxygen mask on first—your child or yourself?

And of course, the correct response is “yourself as the caregiver.” Without ensuring that you will not lose consciousness because of a lack of oxygen, you put both yourself and your child at risk.

Once family members get past their concern about spending time focusing on themselves, they tend to become much more open to the idea of developing their own personalized self-care plan. As part of the check-in for the remainder of the group sessions, you can ask each participant to briefly discuss one way in which they took care of themselves the previous week. The idea is to help them become as attentive to themselves as they are to their family member.

Activities

Since it can be difficult for some participants to jump into a discussion about their own personal “Self-Care Plans” (Exercise 5.3) it might be wise to work on this activity as a group (similar to the way you would facilitate the discussion and activities during the “Impact on the Family’ session.) We recommend that you start off with some of the other activities included in the chapter on self-care, rather than moving straight into the self-care plan activity. For example, ”Identifying the Quick Wins” (Exercise 5.1) and “Stop-Start-Continue” (Exercise 5.2) tend to be easier for participants to discuss and complete because they allow easy identification of the specific behaviours and perceptions with which they are satisfied and those that are a source of concern. These behaviours and perceptions can be associated with easily accomplished actions, which in turn can lead quickly to feelings of success and mastery.

We recently added another activity we call Assessing Resilience (5.4). This followed from a discussion we had in our group about family resilience and “hardiness” and from questions about whether caregivers and other family members could in fact strengthen their ability to be resilient under stressful circumstances. Facilitating a conversation about what “resilience” means to different group members, and perhaps about what factors seem to be most common in “resilient” people is helpful before giving participants time to complete the Resiliency Quiz (developed by Patricia Morgan) and discussing the items on the quiz and participants’ scores (let each group member choose whether or not to share their score). This whole notion of the ability to “bounce back” after suffering extremely adverse circumstances is not only of great interest to family members, but is an area frequently discussed in the literature on families, mental health and substance use problems.

Next >>>