Goal Setting in Recovery Envisioning a Rich and Meaningful Life

Foreign. I'd like to welcome everybody. Today's presentation on goal setting in recovery, Envisioning a rich and meaningful life.

I AM your host, Dr. Donnelly Snipes.

Over the next hour, we're going to explore why it's important to envision a.

Rich and meaningful life. Why are we even going to bother with this? We'll explore how to identify and envision a rich and meaningful life and how to set goals to achieve that rich and meaningful life. It doesn't mean much if you envision it, but you can't achieve it. Why are we talking about envisioning?

Well, a lot of times when people come into recovery or come into counseling.

One of the things that they want.

Is a better life.

They're sick and tired of being sick and tired.

Well, that's good. Great.

We know we want to eliminate those, but what do you want life to look like when you are recovered, when you are happy, when you are whatever? And that's what we call a rich and meaningful life.

And it differs. For every person. Envisioning is a destination. It helps people see where they're going.

And why what they're doing now is really worth the effort. Guided imagery can help people sustain that vision. So daily envisioning, I encourage people, once they go through this process and they create their goals, to spend a few minutes every morning, I like in the morning, because that's when your energy battery's all charged and you're figuring out how you're going to spend that energy throughout the day.

Spend a couple minutes in the morning.

Envisioning this destination and where you want to be in a month, three months, six months, five years, in order to sustain that vision. So you remember, all right, this is why I'm getting out of bed and doing this today.

Envisioning also helps maintain motivation because when.

You'Re seeing that future, when you're seeing that rich and meaningful life, you can.

See how it's going, how you're going to feel better physically. You're going to see how it's going.

To make you happier. When you achieve that, you're going to see how it makes sense. What you're doing right now will help you get, you know, to that rich and meaningful life.

You're going to see what your environment.

Looks like and recognize the things that you want to have in that environment. When you're envisioning this future, you're seeing yourself. You're not seeing yourself in a vacuum. You're seeing yourself surrounded by, you know, fill in the blank, whether it's woods or the beach or friends or whatever it is.

And relationally, you're going to envision this future and you're going to see people in it and you're going to see the quality of relationships and hopefully you're.

Going to see yourself having fun with people.

When you're envisioning this and keeping those.

Things in the forefront of your mind, how is this going to improve your self esteem, esteem and your relationships, your environment, you know, and how you feel physically and emotionally, all of that stuff helps keep motivation moving in the right direction.

Envisioning can also help people prepare for obstacles. And in acceptance and commitment therapy, this is called living in the and recognizing.

That when you're going through, just like when you go on a vacation somewhere and you're driving from, I don't know, middle Tennessee to California, you're probably at some point along the way going to encounter either rainstorms or construction or something else that you hadn't anticipated.

It doesn't mean you can't get to your destination. It just means you've got to embrace it.

Okay, now we're driving, you know, we're, now we're taking a detour. Let's embrace that. Live in the and life is not going to exist without obstacles. Recognizing that and developing the flexibility to say I can have a rich and meaningful life and deal with this obstacle. At the same time, knowing your destination.

Can also help you act purposefully when choosing actions and reactions. If you think about it in the.

Morning, where you want to be, what you want to do, what's important to accomplish, then when other things come up, you can choose whether to spend energy on them. So for example, if I want to improve my relationships with my best best friend, that requires time, that requires me to do things. It's not just going to magically poof, improve. And so I think to myself, when something else comes along, do I have time to do this or do I want to make sure that I have that time set aside to spend with my best friend? Knowing your destination, going back to it every time you have a choice about how to spend energy and asking yourself, is spending my energy on this thing important to helping me achieve a rich and meaningful life? And what are my options?

What's the best way to respond to.

This situation in order to help me move closer and create and embrace that rich and meaningful life?

Rich and meaningful life as they, as.

We talk about in acceptance of commitment.

Therapy incorporates aspects of hardiness that were.

Proposed by Kobasa in 1978. Commitment, control and challenge and One of the biggest things with hardiness is commitment.

Recognizing that there are a lot of.

Things in your life that you're committed to. You're committed to this vision, and you can accept challenges that come along the way.

There's been tons of research that's been.

Done on people who have had some sort of physical health issue, cardiac issues, amputations, what have you.

And they found that people who have.

Higher levels of hardiness are better able to recover. They have a faster recover recovery, and typically have a better physical and emotional.

Recovery when they can embrace the things they're committed to.

Yes, I want to have a rich and meaningful life, and I'm going to embrace that.

Despite the fact that I.

Had this obstacle here. You know, it's not exactly as I had envisioned. I now have a pacemaker or I now have an artificial limb or. Or whatever.

But they are willing to live in.

The end and say, I can have a rich and meaningful life and.

And have this unexpected event come up. Control focuses on encouraging people to identify.

What, in every situation that they can control.

We're committed to a lot of things. There are a lot of things that.

We want to do in our life. You're committed to your health, your family, your job, you know, whatever it is.

Lots of things you're committed to now, what aspects of those things are within your control.

And recognizing that and embracing that is really important.

So people are not constantly trying to.

Change things they can't control and then.

Getting frustrated and then finally challenge is viewing something right in that happy medium.

Where it's not so easy that you're not motivated to do it, but it's not so hard that it's overwhelming.

People who have a certain level of.

Hardiness often view things as.

As challenges.

You know, I've shared with you guys before. When I had my last surgery, my doctor said it would probably be, you know, six to eight weeks before I could start running again.

Well, that was a challenge to me.

And I said in my mind, not.

To her right away, but I said.

In my mind, no, I'm going to be back to running in four weeks. And sure enough, you know, I set my mind on it. I was envisioning that goal, and, you know, things could have happened where I might not have made it, but I.

Did what was necessary to make sure.

That I could achieve that goal, because it was, you know, part of it was a control thing, I'm sure.

So how do we help people envision.

A rich and meaningful life?

I usually just do it very systematically.

I know That's a huge surprise to y'. All.

Starting out with physical health, and we.

Go through the pacer dimensions. Physical, affective, good, cognitive, environmental, and relational.

So, physically, what do you want in your rich and meaningful life?

What do you want in this domain?

And I'm going to give you some different examples.

Not everybody's going to have the same goals for their rich and meaningful life.

But this just helps us apply it. And I encourage you, while I'm going through this, to think for yourself in your rich and meaningful life.

You know, now and five years from.

Now, what parts, what aspects of your physical health are important. In this particular example, the person says.

I want to live to know my great grandchildren.

Okay, well, that means you want to.

Live to be a ripe old age of something or other.

The first thing to ask yourself is, what am I currently doing?

That undermines that.

So if somebody is, for example, smoking.

And we know that smoking is related to a whole lot of diseases and cancers and this and that, well, that.

May keep them from living to that.

Ripe old age of 102 or whatever they're hoping for. Why do I do it?

And that is such a crucial question.

When we look at our current behaviors.

We do them for a reason. They serve a purpose. Behavior is a form of communication.

So we need to ask ourselves, you know, in this particular person's case, if I want to live to be that ripe old age and I am smoking right now, which may undermine that progress.

Why do I do this? Well, for a lot of people, they.

Say stress management and nicotine addiction, those are kind of your two biggies that go hand in hand. What could I do differently? Well, obviously in that this particular scenario, it would be stop smoking.

So the first step for that would.

Be maybe to learn about the options for nicotine cessation. And the next step might be talk to your doctor, or vice versa.

So that's something that a person can do to identify things they're doing right.

Now that are moving them backwards. They're moving them away from that rich and meaningful life, or potentially undermining themselves.

Figuring out why they do it and.

How they could meet that same need in a healthier, more effective way in order to help them achieve their goals.

The next question, it sounds, seems a little bit repetitive, but it's really not. The first thing we're looking at is.

What things do you need to eliminate? What things are you doing that work against you?

The next question is, what else do.

I need to do to make that happen? What do. What might I need to Add into my life and a lot of times.

You can do a Venn diagram and.

Sometimes what I'm doing that's undermining and what I need to do differently. Positive are one in the same, but.

Sometimes they're very different anyhow in terms of living a long life so I.

Can know my great grandchildren.

Exercise, sleep, maintaining circadian rhythms, nutrition, stop.

Smoking, moderate or stop drinking and manage stress.

Those are all things that we want to assess for and help people look at in order to determine what might.

Undermine their goal of a rich and meaningful life. Excuse me.

75 to 90% of illnesses and diseases are stress related. And you can click on the link.

In the PowerPoint and go to the journal articles and stuff, but that is.

A fabulously huge number.

And that particular number comes from the cdc.

Sleep loss impacts the cardiovascular, endocrine, immune and nervous systems.

So we know cardiovascular is the heart and lungs. Endocrine can be like diabetes and it can also be any of your other hormones, your testosterone, estrogen, those sorts of things.

Immune system and then the nervous system.

Our ability to handle stress. Our HPA axis is activated. Our HPA axis is actually hyperactivated when.

We don't get enough sleep. So sleep loss is really a big thing.

If we want to prevent body breakdown.

We need to make sure people are getting good quality sleep for at least.

Seven to nine hours a night. For the average adult, you're actually just little side note here.

As you age, your need for sleep.

Does not go down. And that is a common myth that people who are in their older years only need a couple hours of sleep per night.

That's actually not true.

If you go and read the research on it, they happen to start having more difficulty sleeping through the night because of some biochemical changes.

But it is important to assess their sleep quantity and quality.

They need that solid. 7 to 9.

50% of all American adults have preventable.

Chronic diseases related to poor nutrition and physical inactivity.

My point here is that between stress management and doing basic things for health maintenance, people can extend their life duration.

As and improve their quality of life dramatically. Sleep, nutrition, exercise and stress management.

You're going to hear that keep coming.

Up over and over again today, which.

Should kind of give us a clue that there is a mind body connection.

There's a lot we can do as clinicians to help people address cognitions and, you know, causes of anxiety and depression and stuff that are cognitive. But it's also important and sometimes interpersonal. But it's also important to recognize the causes of systemic Dysregulation that may cause depression and anxiety, symptoms that are physiologically based.

Another physical health dimension that I hear.

A lot from people is I want to have less pain or I want to live with a manageable level of pain.

People who have rheumatoid arthritis or some other sort of chronic pain recognize that it's probably not likely or not realistic to expect to be completely, completely pain.

Free all the time.

And quite honestly, if you read the different articles, it's not realistic for anybody.

To think that they're going to be completely pain free all the time. We're going to have occasional kinks in our necks and aches and pains.

But for those people who have chronic pain, and that's upwards of 20 to.

30% of adults who in America who struggle with chronic chronic pain on a daily basis, they want to have a life where they can have less pain, where they can manage their pain.

And we do know that there are.

Some things that exacerbate pain.

So the first question is, what do.

You do that undermines your ability to manage your pain? And one of the things that comes.

Out for a lot of people is so stress. When we are stressed, especially when we are chronically stressed, that creates a cascade.

Effect because of the activation of the HPA axis that leads to widespread systemic inflammation.

What does inflammation mean?

Inflammation means pain.

When people are stressed and they have.

Autoimmune issues, that usually makes the autoimmune.

Issue worse, which usually makes the pain worse.

So, so part of managing chronic pain.

Would be stress management, other parts of managing pain, and it depends on the.

Person and what the, what their doctor happens to say. Obviously we're not making recommendations for physiological treatment.

For a lot of people, exercise is really important. Think about a time where you have.

Been in a car for, for five hours, seven hours or something, and you get up and you're just like, it hurts to move because your body's kind of like frozen or gotten stiff. Or if you've been on bed rest for a long time and you start to get achier.

Exercise is actually good for the body. It just has to be limited to what the person can do safely, effectively.

And that will improve their situation as opposed to make it worse. For example, I have bad knees and I love to run, which works against a lot of my other goals.

But if I go out and run, it's going to make my knees hurt worse.

So that undermines me wanting to have less pain. If I ride the bike, you know, the spin bike or swim, then that doesn't hurt my knees and it actually helps me feel more energized. Exercise also helps balance out muscle muscular imbalances.

And we've seen that sitting is the.

New smoking, yada yada.

So it's also important to recognize that.

Getting our blood moving, even if you don't want to use the bad word, exercise, getting our blood moving is important to our overall health.

Sleep is important for pain management because sleep deprivation triggers the threat response system.

Which causes systemic stress, which increases inflammation, which can increase pain, and it can.

Also make us just crankier.

I don't know how you are, but I know when I don't have enough.

Sleep, it's a lot more difficult for.

Me to deal with life on life's terms just because I'm exhausted.

Nutrition is super important for for pain.

Management and we're not going to make dietary recommendations unless you're a registered dietitian.

However, recognizing when it's important to make that referral to help people achieve their.

Rich and meaningful life is important. Things like omega 3 fatty acids and certain nutrients are helpful to reduce especially joint pain.

But then there's also a lot of.

Other nutrients that are involved in making the neurotransmitters like serotonin and GABA that help and dopamine that help with pain management and our endogenous opioids.

So there's a lot of chemicals we.

Have in our own body that our body has to make that are necessary for pain management. And if we don't have the nutrition, we don't have the building blocks to make those chemicals, then we're probably going to feel more painful.

We already talked about stress management for.

Pain, which again highlights the pattern of the mind body connection.

There have been a lot of other studies that have indicated that meditation and.

Guided imagery, tens units, acupressure, heat, ice.

There are a lot of non pharmacological.

Interventions that people can use to address their pain.

So we may want to assess, you know, what have you already tried a lot of times, especially with older people.

I've found, who aren't as savvy with the Internet and maybe are used to relying on just doing what the medical professional says.

A lot of times they haven't tried.

A lot of other things. They may not even think of ice or heat or anything like that, assessing.

What have they tried and what works. If you know, for my tmj, a.

Lot of times the doctor will say, you know, heat. And I'm like, no, ice, ice works for me. He doesn't do a dagum thing for me, but I know me. I know what works for me.

And it's important to remember that the.

People we're working with are the experts on themselves.

But pain, chronic pain, can contribute to.

Anxiety about it getting worse.

It can contribute to depression, a sense.

Of hopelessness and helplessness. It can contribute to feelings of grief and guilt because they're losing some of the function that they used to be, things they used to be able to do. Or they may feel guilty that they can't do all the things they used to be able to do.

So paint can have a lot of tentacle effects into our physical health, our.

Interpersonal health, as well as our emotional health.

And it's important to really realize that, which is why I think, is one.

Of the reasons that Jaco has mandated in clinics that we do screen for pain.

But it's also important just to recognize.

How pain affects the body.

The next part of a rich and meaningful life is affect. So the first part is physical, and depending on your person, what's important to.

Them physically for a rich and meaningful life, you know, may differ.

For my stepfather, for example, playing golf.

That was huge for him, and it.

Was kind of catastrophic when he got to the point that he could.

Couldn't play golf anymore. And. And there was a couple of years there where he was going downhill, losing balance and having back pain and things like that.

But he wanted to be able to.

Play golf as long as he could, and that was super important to him. That would have been one of his physical things in a rich and meaningful life.

So we need to prod people a little bit to help them really figure out what is it that makes me.

Happy, what do I need my body to be able to do for me?

Once they've identified a couple of things.

There, you don't have to have the whole laundry list. They can always add to it later.

Then we go down to affect.

Most people have generally the same goals in the affective dimension. They want to be happy.

Go figure. But that can also mean for some.

People that being less anxious and depressed.

Depending on your clients.

If you have a client who has.

Schizophrenia, for example, they probably want to be happy, too, but they also want.

To be stable on their meds. And we know that a lot of the atypical antipsychotics do have some.

Side.

Effects that impact people's moods.

So we want to ask them, what.

Do you want emotionally to be like in 3 months, 6 months, 12 months?

What do you currently do that undermines that? And a lot of people are kind of.

Struggling in, in this one right.

Now because a lot of people are.

Watching the news incessantly or dwelling on things that are out of their control, which is contributing to their anxiety and depression.

Why do we do it?

Because we want answers. I mean, it makes sense why we're doing it.

What could we do differently?

And I've talked about this in multiple other presentations over the past month or so.

Turn off the news. Get your daily dose of news, 30 minutes, whatever it is.

Get the information that you need so you don't feel like you're completely disconnected.

And then turn it off. Hearing the same thing 23 times is.

Only going to make you feel more trapped or hopeless or helpless.

What can we do to improve our affect? And we want to assess people in these different dimensions. Exercise we know.

I know this is a pattern.

Exercise we know helps release endorphins, it.

Increases oxygenation, which increases energy levels and.

It increases serotonin levels. It also has been shown to alter.

Hormone levels, sex hormone levels in a positive direction. Exercise is a good thing for mood.

Exercise doesn't have to be going to.

The gym and getting your heart rate into target heart rate training zone.

Exercise can be taking a walk around.

The neighborhood, playing with the dog, doing something to move around and get your body moving. Not everybody is going to, to want to go to the gym now. There are additional benefits if you do work out at a moderate intensity at least five days a week. But not everybody's interested in doing that and that's okay.

You know, everybody's different. Sleep helps a lot with affect because during, during the day and it also.

Helps a lot with cognition and they kind of go hand in hand.

When you don't get enough sleep, you.

Don'T clear, clear out the adenosine, you don't reset your brain so you're ready to take day.

People who are sleep deprived tend to.

Have higher levels of anxiety and depression and more difficulty concentrating and remembering. So again, sleep is important.

We want to assess nutrition for the same reason as we talked about with pain. We need to make sure that people.

Are getting the building blocks they need.

To make the neurotransmitters that they need to feel happy. They need to be able to break.

Down proteins to make norepinephrine, dopamine, serotonin, gaba.

Stress management is important for affect.

If we are stressed out, we're going to have a hard time being as happy.

People who are stressed out chronically also.

Have difficulty getting quality sleep because they go to bed and they're still anxious and kind of ramped up.

We want to help people identify ways that they can increase positive triggers in their environment. What is, what can you look around.

And see that will make you happy.

And eliminate distress triggers?

If there are things that you look around and see that make you unhappy. For me, and I know I've shared.

This before.

Looking around the house if.

It'S clean and the flat surfaces are empty makes me very happy. Getting up in the morning to a sink full of dirty dishes or coming home to flat surfaces that have piles of stuff on them makes me very unhappy. So I know that's one thing that I am going to devote energy to.

To making sure that when I after.

Dinner I do all the dishes so the sink is clean in the morning.

So I'm starting off the day in a good mood. We want to also help and assess where they are in terms of distress tolerance skills, help them enhance distress tolerance skills and identify and address their causes of anxiety.

Remember my favorite pyramid, Maslow's hierarchy? That base level is your biological needs.

If we are not getting our biological.

Needs met or if we're afraid we're not going to meet them, we're not.

Going to probably be real successful at.

Being happy and stress free.

The next level up is safety. And if we're not feeling safe emotionally or physically, it's going to be hard for us to feel happy. And the third level, and I kind of stopped there, the third level is love and belonging.

If somebody struggles with abandonment anxiety, if they struggle with issues of rejection, if they struggle with low self esteem esteem.

They'Re probably going to have difficulty with.

Anxiety which is going to detract from their energy available and time available for happiness.

So we do want to, as clinicians we do want to address the causes.

Of people's anxiety and depressive symptoms and.

Help them figure out, okay, what steps.

Can you make, what steps can you take in order to start eliminating or addressing some of these things.

Cognitively? This one is kind of small for.

A lot of people, but I put it in there.

For example, some people say I want.

To be sharp and continue learning if you expect or one of your, one of your physical goals is to live to be 102.

You're probably going to want to have.

Your faculties, you're probably going to want.

To be cognitively sharp in, in your older years. So it's important to recognize what can I do. And I have a video. I found some really awesome research on preventing.

There are actually I think 13, I could be wrong, 13 causes pre that Preventable causes of dementia.

So if you look on the YouTube.

Channel on addressing dementia and cognitive decline, you can find some of those. Hearing loss is one of them, with social withdrawal is another.

Stress and anxiety. And interestingly enough, depression is correlated with cognitive decline. We want to look at what people.

Are doing to enhance their, what they call cognitive reserve. So to keep learning, to keep using that. The brain's not a muscle, but we'll call it a muscle. For right now, just, you know, keep.

That, keep your brain working.

Are they doing, you know, things that are creative? Are they moving their body? They found that it's really important not only to exercise and flex their mind, but also to move their body, even if that's just, you know, slow movements. Chair, tai chi, anything like that that can help them increase oxygenation also helps with cognitive functioning.

What else can you do to make this happen? And obviously I've highlighted some of these.

Things so you can look at the specific articles related to how exercise, sleep, nutrition and meditation have all been found to slow the process of cognitive decline. As we get older, we are going to slow down a little bit.

Now, you don't necessarily slow down a.

Ton, but just that's the way the body functions.

People who are older do tend to.

Have slower cognitive response times, but they.

Found that what's called cognitive, cognitive resources. I think the more cognitive resources you.

Have available, the slower that decline.

So think of it like a stockpile and you know, kind of like a.

Lot of us have a stockpile right now getting ready for quarantine.

People who have more stuff stockpiled, they.

Have more knowledge, they have, and they're actively engaging all of those, not all of them, but engaging those different synapses on a regular basis.

They're keeping their brain healthy.

And that actually slows the cognitive decline process.

Environmental when we envision our rich and meaningful life or when you envision yours, because this is very personal to every individual.

What do you want in this domain? And I remember my grandmother wanted to live out her years in the house that she and my grandfather had purchased 35 some odd years ago. And unfortunately for her, that became an impossibility.

But some people may say, you know, I want to live to be 102 and I want to be able to.

Live independently in my own house.

So the question is, what needs to happen? Or what do you need to do.

In order to make that happen? What do you do that undermines that right now?

If you do things for. People who do things that can contribute.

To cognitive decline are probably going to need to be have some sort of assistance if either in their house or at an assisted living facility.

People like me who are stubborn, who.

Go running on bad knees anyway, you.

Know, it's really hard to live independently if your knees don't work anymore. Looking at what are you doing that.

May be undermining that and what could you do differently?

So like I said earlier, I can.

Ride the spin bike, I can swim. There are a lot of things I can do for cardio, respiratory exercise that don't destroy my knees.

And that's important because I'm getting to the age where I start.

You know, we have three flight, two flights of stairs, three levels in our house.

And I'm getting to the age where, you know, getting up and down those.

Stairs some days, especially after I've run is more difficult.

And I'm recognizing that if I want.

To be 75, 85, 95 years old and living independently, I'm going to have to do some things differently.

And they may, you know, in this.

Rich and meaningful life, if this is something they want to do, live independently and they currently live in a multi story house.

One of the things they may consider.

Is moving to a one story house or putting in structural accommodations like those little elevator things that take you up the stairs.

You know, there are a lot of options out there, but it's important for.

People to plan for those things. If living independently is going to be a huge important thing for them, then.

We need to figure, help them figure.

Out how to make that happen.

Especially if they're starting to get older. But even people who are in midlife like me, need to consider what am.

I doing now that might prevent me from living a long, rich and meaningful life independently?

What else can you do to make that happen? Exercise.

I know we're coming back to that one again.

For my grandfather or no, sorry, not.

My grandfather, for my stepfather, for example.

Exercise was really important for him to.

Be able to maintain his stability so.

He could play golf.

But it was also important for him to exercise in order to do his.

Physical therapy in order to maintain his.

Balance so he could live independently in the house. And their house had three levels that they had to traverse on a regular basis.

Sleep is important in for, for a lot of people, for their environment. Because when we're sleepy, a lot of.

Times we have less energy to clean, less energy to attend to our environment. We tend to want to stay asleep, we want to stay in the dark.

You know, when our circadian rhythms get.

Out of whack, it can really Impact our environment. A colleague of mine once said, and I've stolen it and held on to it henceforth and forevermore, that the way.

Your outside looks often reflects how you.

Feel on the inside. So if your outside is in complete disarray, if it is dark, if it is dusty, you know, that may indicate something about how you're feeling on the inside.

Nutrition is important in order to make sure that you have the energy in order to create this environment that you want. Because environments like relationships and everything else.

You don't just wish them and they happen. You know, I wish I started watching I Dream of Genie reruns again. Yes, I've gotten desperate since quarantine started.

And, you know, yes, I wish I.

Could, you know, cross my arms and blink and the house would be clean, but it ain't. So.

So we need to have the energy.

To make that happen.

We need to be able to manage our stress and manage our time so we can create this environment that is pleasing and relaxing. You can't benefit from a gorgeous environment if you are wound tighter than a drum or.

I don't know why they say that, because drums aren't really wound.

But I digress.

Sorry.

Y' all look at structural accommodations too. If you're working with a client who.

Has this as a goal, and they're getting to a point where they may not be able to live independently in, you know, the next five years, having either a rehabilitation counselor, a consultant, somebody go in, look at their environment and identify reasonable accommodations in their environment to help them stay there longer.

And some people will need to look, even consider financial planning for long term care. Some people can make it if they.

Are living independently in their house, you know, they're not in an assisted living.

Facility, but they have a caregiver that.

Either comes in and checks on them every day or lives there with them.

So those things are important to check. We also want to, as I mentioned.

Earlier.

Look at other things that might.

Contribute to changes in our environment.

And this is one of the lesser things that people usually put on their.

Rich and meaningful life.

But I do want to emphasize how important context is. You can have, you know, a lot of good ideas for positive things and you can be taking care of your health. But if you live in a dungeony crap hole, then it's going to be.

Harder to be happy. Our environment is so important.

And finally, relationally, and this includes self.

Esteem, people's relationship with their self, as.

Well as their relationship with other people, asking them, you know, what do you want in this domain? And a lot of people say I want to have a great relationship with.

My family and friends. You know, how many times have we heard that?

Lots. The challenge or issue here is that that doesn't just poof, magically happen. Again, we are not genie, we can't blink it up.

We have to put some work into it.

So what do you want that relationship to look like?

A great relationship, in my opinion may be very different than a great relationship in your opinion.

So what does this great relationship look like? Are you texting each other all day, every day? Are you calling each other every day?

Are you, you know, going out once a week? You know, there, there are very big differences in what people consider adequate communication and a quote great relationship.

So we can help people describe the.

Characteristics of a great relationship and that's going to be really important to describe.

What a quote great relationship looks like and then figure out how to get there. And like with everything else looking at.

What do I currently do that undermines great relationships?

Personalization and mind reading are two cognitive.

Distortions that come up a lot when.

We take everything, you know, too personally.

My stepfather was supposed to call me this weekend and he didn't and I got busy and I didn't call him either. But if I was going to take it personally, I could think, oh, he's mad at me. Or you know, take it as some sort of an insult or something instead of assuming that hey, maybe it was a nice day and he went out to see the horses, you know, who knows?

But it's important to help people recognize.

Things that they do that may undermine.

Their relationships with other people, but also may contribute to a low self esteem.

If I take everything negative that happens in my world as a reflection on me, somehow it was about me, they didn't like me, they didn't something then that is going to just destroy my self esteem.

Poor communication skills, not asking for what.

You need, not being able to be.

Assertive and say this is what I.

Need and then getting all, all irritable.

When people don't meet your needs.

It's like, well, if you're not asking.

For what you need, you can't expect.

Them to reach your mind.

Encouraging people to develop assertive communication skills. So we need to assess for how much of their problems in their relationships are caused by poor communication skills and.

We can help them enhance those.

And poor boundaries, you know, is the.

Other one that often comes up.

Some people are very needy, very clingy.

Because they have a lot of fear of abandonment. So they need to be with, you.

Know, joined at the hip with people.

A lot of times, and they need to a lot of times. That also means they have very poor emotional boundaries, too.

And that doesn't usually create healthy relationships.

So we want people to examine what their boundaries are like, if they need to improve their boundaries, and how improving boundaries could help them create these great relationships as they define them.

And finally, what else can you do to make these things happen? Sleep again, a lot of times, if we are sleep deprived, think about if.

You'Ve ever had a young child at home.

When you're sleep deprived, it's hard to.

Garner the energy to focus on anybody else. You're just trying to get through the day. So sleep is really important.

Stress management, same thing. If you're using all of your energy.

And burning it up on stress emotions, then by the end of the day, you just want to come home and, like, flop on the sofa, which means you're not going to use any energy for quality time with friends. So do you want to use the energy balled up with stress, or do you want to use the energy, save some of it, at least for spending time with friends in the evening?

And that people can ask themselves, you know, during the day when they start feeling themselves, get wound up, you know.

I need to conserve my energy. I need to take a deep breath because I want to have energy to be able to go out tonight.

And that can really help them purposefully.

Think, how am I going to use my energy? Am I going to use it to.

Get all freaked out?

Or what could I do differently?

And time management is really important in relationships because, you know, that old adage.

Of sort of out of sight, out of mind.

A lot of times our friends are.

Not, like, within our view.

And when we're at work, our kids.

Are not within our view, so we may forget that we intended to do something with somebody or we meant to say something, or we had intended to text.

Planning quality time with those people is really important.

At our house, we have, you know, still dinner time. We all come down and we all spend, you know, that 30 minutes or more eating dinner, talking about the day. My kids are older teenagers, so getting much more than that out of them is, you know, not always gonna, gonna fly.

But that's important. And my daughter usually comes down, I get up early, she gets up early.

So a lot of times in the morning we have quality time where we can, you know, talk and have some meaningful interaction, so to speak.

And that's important to me. So I make sure I get up early.

Enough to spend time with her before the rest of the family and the dogs and everybody else gets up.

But that when I envision a rich.

And meaningful life, I have identified the.

Steps I need to take in order.

To make that happen.

I've envisioned what I want this relationship.

To look like and then figured out, you know, okay, how do I make that happen?

Which takes us to our next slide. And I love doing this as a collage. I am not an artistic person by any, any means, so my collages are usually kind of lame, but they are.

Visual and they help me see things.

So creating a collage on a poster board with pictures that represent your goals.

Health, pain management, affective, you know, happiness.

Eliminating anxiety and depression.

Cognitively being, you know, sharp, you know, may maybe having a picture of some older person who is, you know, super smart and in the top of their game. I don't know, whatever you want to use for the pictures.

Independent living, self esteem, friends and family. Those are the ones that we talked.

About in this presentation. So if you were going to do a collage, on this presentation, you would have pictures representing each one of those things.

And then take post it notes, and on each one of those pictures, you're going to place a post it note and identify the first thing that you need to start doing right now in.

Order to start making that happen.

Whatever it is, that is the first.

Step you're going to take to creating that rich and meaningful life or continuing with, you know, sometimes you've already got it and it's a matter of making sure that you continue with it.

Place post it notes on each of the pictures, each of the goals with the first thing you need to do.

To start moving towards that.

And then start each day with guided imagery. Look at your poster. Imagine, close your eyes if you want to imagine what life will be like.

When you've achieved those goals.

And then review those post it notes to remind yourself what you have committed.

Yourself to spending your energy on.

Each week. Go back and evaluate yourself for compliance.

Like, if I say that I'm going to eat dinner with my family every single night, then I'll look back over the week and ask myself, okay, did I do that if I did score.

You know, keep on keeping on.

If I didn't do it, why not? And what do I need to do differently? Because this is important in my life and, or I, I said it was important.

So what do I need to do.

Differently in order to be able to make this happen? Taking my son out driving was one of those things. That, you know, I really intended to do and I set aside time to do it and I just kept forgetting to do it.

So I ended up putting a reminder.

In my phone that alerts me at 6am every Sunday morning that I'm going to be taking him driving after breakfast.

And that worked for me in order.

To help me do that, because I.

Wanted to do it and I had set aside time to do it, but then I would forget about it. So it's important that people are able.

To evaluate what they're doing if they're.

Not fulfilling, if they're not taking that.

Step, ask themselves why not and what they need to do differently. And then each month, and I like.

To do solid blocks, you know, sometimes.

You'Re not ready after a month, but.

Doing something new for a month starts.

Getting it ingrained into behavior patterns.

So at the end of each month.

Or the beginning of each month, however you want to do it, add a.

New post it note to each goal.

Representing the next step you're going to start making.

Recognizing that getting to your.

Goal of happiness or pain management, whatever.

It is, it's probably a multi step process. So do the first step, do it.

For a month, then do the next step and do it for a month and so on until you've achieved your goal.

It's much more likely that people are.

Going to be able to sustain their behavior changes if they do them incrementally and slowly instead of trying to do something as fast as they possibly can.

We all want a rich and meaningful life. Envisioning that rich and meaningful life can help you maintain motivation, break down goals into manageable chunks, and support purposeful action.

That means using your energy for the.

Positive reason of moving towards your goals.

Instead of just kind of throwing it out the window. Using your energy, spinning your wheels, getting and being stuck in the mud.

Everything won't always be perfect. So incorporating the concept of living in.

The and is important to maintaining motivation. You can have this rich and meaningful life, you can have this vision, and you can have the occasional setback, the occasional obstacle. Just like I said, if you were going on a, a road trip, you know, you can have this vision. You can see Disney World at the end or wherever it is that you're going.

And you can still have a great vacation, even if you have to take.

A detour or even if you have to drive through rain for, you know.

Two states starting each day. Envisioning the rich and meaningful life can help people focus on what they have.

Right now, what's going well and where.

They'Re going, so they focus on the.

Positives in life, and it can help them maintain motivation.

Between writing notes, filing insurance claims, and scheduling with clients, it can be hard to stay organized. That's why I recommend TherapyNotes.

Their easy to use platform lets you.

Manage your practice securely and efficiently. Visit therapynotes.com to get two free months of therapy notes by just using the promo code CEU when you sign up for a free trial at therapynotes.com.

If this podcast helps you help your.

Clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastce that's allce.com podcastce. To sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor. Thank you.