The recent suicide of Robin Williams awakened many of us to the toll depression or bipolar disorder takes not only on the afflicted person, but also on those of us who love and live with the person with a mood disorder. As the tragedy of Robin Williams illustrates, there is no such thing as being “just” depressed. Depression and other mood disorders are serious illnesses, and mental illness should be treated as seriously as physical illness. Partners of mentally ill loved ones are often thrust into the role of caregiver, and self-care is paramount.

Here are some tips for caring of yourself while caring for someone with depression, bipolar disorder or other mood disorders.

1. Set healthy boundaries. It is tempting to forget your own needs when living with someone with a mood disorder. Remember that you need to take care of yourself. If you do not, you will become resentful and may suffer burn out and your own depression.

2. Do not isolate yourself. A person with a mood disorder is likely to isolate him or herself. This is a primary symptom of the disorder. It is also often a result of the shame or guilt the depressed person feels. Make sure to maintain your friendships, work life and the activities that give you satisfaction.

3. Learn about the disorder. This will help you understand your partner and give you tools for caring about yourself while caring for your loved one. If he or she suffers from bipolar disorder, learn not to say “he is bipolar.” He or she is not their illness, but someone with an illness. Learning about the disorder will also help you to….

4. Don’t take it personally. A symptom of many mood disorders is irritability and uncontrolled anger. Do not take it personally, as hard as that may seem when your loved one is lashing out and directing his or her anger toward you. Do not argue or defend yourself at those times – it is like trying to be rational with a baby having a temper tantrum. Arguing and expressing your anger at these times will only escalate the situation. If the anger is overly hurtful, disengage, and walk away, as unemotionally as you can, while not suppressing your own feelings. You can say “I know you are hurting right now, but you are also hurting me. We’ll talk after you feel a little better.”

5. Determine if the anger is abusive, and weigh honestly whether to stay or leave. Only you know if the personal attacks are overly abusive and if they outweigh the love and good in the relationship. If you are in danger physically or emotionally, it will likely be best for you to leave the relationship. Abuse is never acceptable. Determine if the angry outbursts and behaviors are simply that or if they cross the line into abuse. If it is only occasional emotional attacks, that may be acceptable, but only you can judge how much it is affecting you and your life.

6. Take care of your own feelings and health. It is important to preserve your own health, both physical and mental, when you are living with a person with mental illness. You need to express your feelings, or you will become depressed yourself. Allow yourself a good cry, take a walk, hit a pillow or stamp your feet to get the feelings out. It is best not to do this in front of your loved one, as this may result in further guilt, shame and depression for him or her. Talk to a trusted friend. Get professional counseling for yourself. Get a massage. Exercise. Stay connected to your spiritual community.

7. Do not try to “cure” or “fix” your loved one. He or she may hope, whether consciously or unconsciously, that you will be a savior/rescuer and cure the illness. Remember that this is not your role or job. Remind your loved one of this gently and firmly, and suggest professional help. This is a big piece in setting a healthy boundary. Do not nag about that, as tempting as that may be.  Make suggestions once, avoiding the word” should.” He or she will hear you, and may just not be ready to take the necessary steps toward healing. Remember that only your loved one can choose to get the help he or she needs, and forcing him or her into therapy or into taking other steps will backfire if he or she is not ready to commit to the process.

8. Do not feel guilty about your loved one’s depression or other mood disorder. Remember that you are not responsible for it. Offer support, understanding and love, and again, don’t take it personally.

9. Do not make excuses for your loved one. Unfortunately, the negative symptoms of a mood disorder, such as undue anger, irritability and self-isolation, often spill over into other areas of your loved one’s and can affect your relationships with others. Let your loved one know that you will not make dishonest excuses, while assuring him or her that you will not divulge confidential information. If we all start saying “We would love to see you, but my partner is dealing with depression and is unable to go out tonight” we will begin to take away the stigma associated with mental illness. We have no problem excusing ourselves when we have a cold – why should it be any different with symptoms of a mental illness?

10. Be willing to engage in activities without your loved one. This goes hand in hand with not isolating yourself. If your loved one’s illness prevents him or her from keeping a social commitment, go yourself, especially if it is a commitment with a friend or community that nurtures you.

11. Have compassion for yourself, and acknowledge the good you are doing. Living with someone with a mental illness is a difficult challenge. Know that staying with your loved one and acting in the best interest of both yourself and your partner are acts of courage and compassion. Remember that you cannot have compassion for another unless you have compassion first and foremost for yourself.





Tips for Preventing Professional Overload, Stress and Fatigue

It is natural to try to do your best at work.  However, there is a big difference between working hard and overwork. A little bit of stress is okay, but not if it is affecting your emotional or physical health, or is a step away from burnout.   Here are some tips for fatigue management that will help you prevent burnout:

1. Know your “early warning signs” of over-work.  A bit of stress can be seen as a helpful wake-up call to slow down and take care of yourself. Some early warning signs include irritability, difficulty falling or staying asleep, forgetfulness, self-criticism, clumsiness or feelings of hopelessness.

2. Be intentional in slowing down.  Do something relaxing and fun, whether it’s a bubble bath, walk in the woods, listening to music, dancing, laughing or whatever fuels and nourishes you. 

3. Reach out for support from your peers, friends and families.  Create opportunities to debrief from a difficult work experience.  You don’t have to be a hero and go it alone.  If you are being triggered emotionally by an event at work, whether it is reminding you of something difficult or traumatic from your past, you are having a difficult relationship with a co-worker, or communication or assertiveness issues, you may benefit from professional guidance, from a skilled psychotherapist or counselor or from your Human Resources or EAP program.

4. Be kind to yourself.  Remember that you don’t have to — and can’t — be perfect.  Give yourself a break.  When you are feeling overworked, overly stressed out and in need of fatigue management, give yourself a gift that nourishes you.  Reward yourself for a job well done.

5. Stay healthy through restorative self-care.  As your mother always told you, get plenty of sleep, eat healthily and exercise.  Without a healthy physical foundation, the rest falls apart.  Walking, yoga and meditation can be extremely helpful when you are stressed out.

6. Set healthy boundaries.  It is OK to say no or ask to postpone an assignment, if possible, when you are feeling over-worked and don’t think you can take on another chore at that moment.

7. Leave your work at the office, even if the office is in your home.  Turn off the cellphone, iPad and computer.  Remember that the work will always be there.  Be mindful of when you are giving energy to a work assignment or work experience when you are “off-duty”, and find your own way to put it on the back burner. One way to do this is to create rituals to end the work day. For example, several years ago, I was facilitating a very emotional grief support group.  After each session, I would ruminate about the work we did and the feelings expressed on my entire ride home.  I would then talk to my husband about the group (without divulging identities or confidentiality, of course), and go to sleep still thinking about it.  This obviously wasn’t working, and I was feeling the signs of burnout, so here’s what I did instead, which helped tremendously and are tools that I continue to use:
I visualized a container in which to put everything away until the next session.  My container was a jewelry box with a lock — I would mindfully imagine putting away the work and experiences of the group in the box and locking it with the thought that it would all be there next week. I intentionally walked to my car, with the thought that I was leaving the group behind until next week.  When ruminations about the group came up, I would gently let them go. I no longer told my husband about the group, unless it was something that would nourish me.  Instead, I took a calming bubble bath, rewarding myself for a job well done.  
If racing thoughts occurred as I tried to sleep, I sent my energy away from my head and down to my feet, and let go of the thoughts.

8. Reflect on powerful or difficult experiences through journaling and the support of peers, spiritual teachers and mentors to recover a sense of meaning, purpose and connection in life.

Top Ten Ways to Prevent Professional Caregiver Burnout

Those of us in the caring professions can have the tendency to give to the point of depletion or burnout.  We bring our natural tender heartedness into our jobs and in doing so, tend to get into patterns of over-giving.  Henri Nouwen has called us the “wounded healers.”  We want to give because we have experienced suffering in life, and can contribute to others because of our own journey to heal our wounds.

As a psychotherapist, grief counselor and a manager in hospice, I know how easy it is to fall into the trap of over-giving.  It affects my personal relationships, relationships with my clients, and most important, my relationship to myself.

Here are some tips for preventing professional burnout.  Here are my top ten tips for preventing professional burnout:

1.  Reach out for support from your peers, friends and families.

2.  Remember that you don’t have to be a hero and go it alone.

3.  Create opportunities to debrief, and use professional counseling when appropriate.

4.  Be kind to yourself and have fun.

5.  Remember that you don’t have to — and can’t! — be perfect.

6.  Stay healthy through restorative self-care and remember to laugh.

7.  Set healthy boundaries.

8.  Acknowledge your own wounded-ness, and use it to be an empathic source of wisdom.

9.  Create rituals to delineate work time from personal time.

10. Reflect on powerful or difficult experiences through journaling and the support of peers, spiritual teachers and mentors to recover a sense of meaning, purpose and connection in life.