Tag: Mental Health

3 Types of Trans Healthcare That Everybody Should Know About

When we hear about trans people and healthcare, we mostly hear about hormones and surgery. But trans people are way more than just hormones and surgery.

As part of my current research, I am learning about the different types of barriers that trans people experience when accessing healthcare. To my surprise, the majority of the barriers discussed were in relation to accessing transition related care – ie hormones and surgery (among other things). I had to dig significantly deeper to find anything on the barriers that trans people face in accessing regular, every day health care.

What I realized was that this was a reflection on society’s view that trans people are one-dimensional – trans. As it turns out, trans people are more than just trans. They are parents and kids and employees and students and immigrants and homeless and artists and athletes. They are just as multi-faceted as cis people – maybe more so!

This goes for their healthcare needs as well. Sure, they need access to things that are specific to medical transition, but they also need access to basic health care. They break bones, get in accidents, have chronic conditions, and get sick just like cis people.

Since this concept seems to be difficult for the medical and research communities to grasp, I thought I would break it down into three categories to make it a bit more straightforward. Here goes.

TRANS SPECIFIC CARE

This category of health care needs is specific to being transgender. These are health care protocols, medications, and surgeries that are only accessed by and applied to trans people. Some of these were created specifically for trans people. Most were designed for cis people but have been adapted in ways that are now seen as separate protocols when used for transition purposes.

  • Hormone replacement therapy (HRT) for the sake of gender transition
  • Chest masculinization surgery (top surgery)
  • Vaginoplasty
  • Orchidectomy
  • Phalloplasty
  • Metoidioplasty
  • Facial feminization surgery (a collection of many different procedures including trachial shaving)
  • Gender dysphoria diagnosis
  • Psychological assistance with gender/sex incongruity
  • Voice masculinization/feminization therapy

TRANS ASSOCIATED CARE

This category of health care needs refer to services that are used by trans people in the course of medical transition but are also used in the same form by cis people.

  • Puberty blockers
  • Electrolysis
  • Hysterectomy/Salpingo-Oophorectomy
  • Breast augmentation
  • Breast reduction
  • Liposuction/sculpting
  • Scar/Skin graft care post gender affirming surgery
  • Hair transplant
  • Hair growth treatments
  • Treatment for conditions related to bottom surgery
    • Pelvic pain
    • Incontinence
    • Urethral stricture
    • Urethral fistula
    • Post-op infection
    • Dilation

TRANS SENSITIVE CARE

This category refers to all healthcare needs that are not related to medical transition. These are basic healthcare needs that may or may not interact with an aspect of medical transition. For these aspects of healthcare, being trans is not the reason for or the focus of treatment but is still an important aspect of the whole person and their experiences.

  • Diagnosis and management of chronic conditions
  • Cancer screening, diagnosis, treatment, and follow-up
  • Mental health support and psychiatric care
  • Disability related care
  • Fertility, pregnancy, birthing, postpartum, and lactation
  • Emergency care
  • Geriatric and end of life care
  • Stroke and traumatic brain injury
  • Addiction management
  • Physical Therapy and other rehabilitation services
  • Preventative healthcare and health promotion
  • etc

If you are a cis person, think of anything you have ever needed the health care system for, or anything any of your cis family and friends have needed the health care system for. Guess what? Trans people need that care too.

It is the responsibility of the health care professional to know whether any aspect of care within their scope of practice will interact with an aspect of medical transition. For example, drug interaction with HRT medications. Even if the care is irrelevant to any aspect of medical transition or their experiences as a trans person, they still need to be treated with respect, dignitiy, and compassion in order to receive the care they need and have a positive outcome related to that care.

Check out my post about how to be a trans inclusive health care professional and find other recommendations about how to be trans affirming in the related posts below. In the coming years, I will be working on guidelines for medical researchers on how to include trans people in clinical research.

Because really, trans people may be unique in many ways but they are also people with regular, every day health care needs who deserve to have equal access to appropriate, respectful care.

Note: Trans people are by no means the only group marginalized by the health care system. People with disabilities are often reduced to their disability. People with chronic pain are often labelled as drug seekers. People who are fat/obese are reduced to a BMI category or number on a scale. None of these types of stigma are acceptable. If you are a health care professional, I challenge you to learn more about the experiences of all of these marginalized groups (and others). But if you’re overwhelmed and need a place to start, you may as well start here, with trans inclusivity.

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Gender Inclusivity in the Workplace: What it is and How it Feels

For the last five years I have worked in the same environment. During this time, my husband came out as trans and I discovered my identity as a nonbinary person. I recently cut back on my hours at this job and started a different job. These two jobs are wildly different environments, types of work, levels of inclusion, and effects on me as a nonbinary person.

For the last few years, I assumed that any workplace connected to my chosen profession would be the same in terms of it’s effect on me with mild variability in inclusivity. But since switching to the new job, I am realizing how much of the burnout I’ve been experiencing is from inclusion related factors, or the lack of inclusivity at my previous job.

A lot of these factors are within the control of my colleagues and management staff. But some of them are simply related to the nature of the job.

WHAT A NON-INCLUSIVE WORKPLACE FEELS LIKE

When going to work at my job that has minimal inclusion, recognition, or support for my identity as a nonbinary person, I have a nebulous feeling of resistance, anxiety, apprehension, disappointment, and risk. I carry this around with me to varying degrees throughout the whole work day. It is distracting and tiring. I feel like I am hiding, shrinking, holding myself in a small tight ball inside myself for the course of the day.

Every time I have a chance to show a part of this aspect of my identity I have to make a risk vs reward calculation. Every time I encounter something that directly relates to or impacts my gender identity, even if it isn’t directed at me, I have to decide if I’m going to hide or react which is again, a risk vs reward calculation.

This isn’t to say that everything about that work environment is bad and negative. There are lots of things I like about it or else I wouldn’t still be working there. But in order to engage with the things I like about that job, I have to bring the rest of this heaviness along with me.

I am not out to the majority of people in this workplace because it doesn’t feel safe or feasible (more on this below). When I am misgendered, it is primarily out of ignorance and assumption. But, because of many factors, I expect that the majority of people would continue to misgender me even if I did come out. This means that coming out is not worth the effort or risk.

WHAT AN INCLUSIVE WORKPLACE FEELS LIKE

At my new job, I am excited to get to work every day. I can focus and do my work efficiently. At the end of the day/week I am as tired as I would expect given the amount of work I did. I still have mild reluctance to engage with people who are not necessarily trans competent but I know that, should I need to correct them on my name or pronouns, I have the support to do that.

I entered this workplace using my preferred name, pronouns, and gender identity. Not everyone I interact with knows all of that information but I feel safe in providing it openly when I need to. I can share any parts of myself that are relevant without fear and with minimal risk vs reward calculation because the risks are much lower and the reward is more likely to occur.

Colleagues recognize the types of knowledge and expertise that my nonbinary identity affords me and come to me when they have things I can help with.

Overall it feels easy, affirming, and allows me to simply focus on my work.

WORKPLACE FACTORS THAT IMPACT GENDER INCLUSIVITY

Culture

This is the factor that we think about the most in regards to inclusivity and it is definitely the most complex one. You can think of cultural factors in three groups: policies and procedures, competence, and representation.

Policies and Procedures

Is there a policy in place that protects workers based on gender identity? Do their policy documents use gender neutral language? If they have a dress code, is it gender neutral? Do their application forms and other types of documentation such as ID and health insurance forms have inclusive fields (sex, gender, legal gender marker, legal name, preferred name, pronouns, neutral labels, etc)? Is the use of homophobic and transphobic language pervasive, ignored, discouraged, or penalized in the professional work spaces as well as the social spaces in the workplace? Is it commonplace to include pronouns in introductions and email signatures?

Competence

Is the management trained in equity, diversity, and inclusion to the degree they need to be in order to put the policies and procedures into practice? Do they know what to do if an employee or colleague comes out as trans or requests they use different language or pronouns for them? Is there positive, neutral, or negative regard for differences and diversity? Are there ‘safe space’ stickers on office doors? Is the messaging around safe spaces and being inclusive accurate to the level of competence of the staff?

See the end of this post for numerous other posts on this blog related to building basic trans competence.

Representation

Is pride month celebrated? Is diversity represented in the company/business promotional materials, staff support messaging, and among the workforce?

I’m sure there are more but these are the ones that come to mind from my experiences comparing these two work environments.

Physical Environment

This factor is a bit more straightforward but often overlooked by anyone who isn’t negatively affected by it. For gender related inclusivity, some of the questions that come to mind are:

Are there gender neutral/single use bathrooms and changing spaces (if applicable)? For places like gyms, yoga studios, and rehabilitation clinics, are there spaces that aren’t surrounded by mirrors? If asking clients about their personal or health related information, are these meeting spaces private (for both sight and sound)? Is the messaging that is visible at the entrance and throughout the space inclusive and representative of diversity?

Social Demands

This is a factor that is often overlooked and took me a while to recognize as important. My experience with it is more specific to gender identity (though I’m sure it applies to many other minority groups as well).

How many social interactions with strangers or acquaintance level co-workers are required throughout a day of work? This is important because, especially for nonbinary people, strangers, and anyone who we haven’t specifically come out to, will make incorrect assumptions about our gender identity and pronouns. No matter how inclusive the workplace is and how comfortable you are being ‘out’ in that environment, every interaction with a stranger requires coming out again.

Many of the components of the other factors make this significantly less onerous. For example if the company’s messaging is clearly trans inclusive, if employees have pronouns on their ID badges, and if the culture is supportive, affirming, and protective of trans people, I would feel much more comfortable introducing myself to a stranger using my pronouns (they/them). If the other factors are poor in terms of inclusivity, this one gets exponentially worse.

But, if the type of work requires very little interaction with strangers, it is significantly easier to get through the day in a workplace that has mediocre cultural and physical inclusivity.

  • What have your experiences been with gender inclusion in your workplace?
  • Have you ever quit a job due to it’s lack of gender inclusivity? What factors affected you the most?
  • How would you rate your current workplace on it’s gender inclusivity based on the factors above (or others that you’d like to add)?

Leave me a comment below or send me an email! I’d love to hear from you.

RELATED POSTS

Workplace and Coming Out

Surviving in a Non-Inclusive Workplace

Trans Competency

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While You Are Sleeping: A Poem to My Baby

Over the course of the last year, the first year of my child’s life, I have experienced many intense moments. Sometimes these happen over a discrete period of time – a moment, a day, or even a few weeks – and then they pass. Other times, like the one described in this poem, these intense moments happen repeatedly, in small bursts, and are related to a particular activity.

For me, one of these has been the emotions, sense of connection or disconnection, and shifts in identity that occur while I’m watching my baby sleep.

While You Are Sleeping

While you are sleeping, 
I watch.
I listen. 
Your fist clenches, opens, relaxes. 
Your breathing catches, slows, deepens. 
Your face winces, smooths, smiles. 
Peaceful.
Makes me feel peaceful.
Because of our connection.
Makes me aware of our connection.
You are the seed of my soul,
Life of my body. 

While you are sleeping, 
I watch.
I listen.
I can't help it. 
I am drawn to you. 
I feel obsessed.
Your peacefulness is a drug. 
It soothes me. 
Slows time. 
Pause. 
Quiet.

While you are sleeping,
I have given you all you need, 
For now, in this moment.
Satisfaction.
Pride.
Confidence.
No demands, frustration, concern,
To overshadow the good feelings.
The powerful feelings.
The awe.
The wonder.
The love.

While you are sleeping,
All your needs are met.
For now.
Relief.
Not being needed.
My body is my own. 
My time is my own. 
My space is my own. 
Freedom.

While you are sleeping,
All your needs are met.
For now. 
Relief. 
Not being needed.
Confusion.
I am not needed.
I am lost, untethered.
Who am I, when I’m not needed?
What do I do, when I’m not needed?
Lost.

I look at you again, 
While you are sleeping,
Peaceful.
I feel our connection.
You are the seed of my soul,
Life of my body.
I am here to protect you, 
Guide you.
I feel the enormity of the role I now live,
Feel myself filling that space and overflowing,
Expanding to be more than I am. 

While you are sleeping,
I have space, time, energy,
To care for myself. 
To care for our space. 
To rest and recharge, 
So I am ready 
For when you awake.

Over the course of the last year my identity as a human and as a parent has shifted a number of times. My relationship to myself and my child has changed, morphed, adapted. This is reflected in the different experiences that are brought out by the same activity of watching my baby sleep. The collection of experiences I describe in the poem happened over the span of our first year together. They aren’t necessarily presented in chronological order but are more of an overall impression of what I can and have experienced or thought about while watching my baby sleep. I hope some or all of it resonated with you.

If you would like to share your own experiences of what it feels like to watch your baby sleep, or another type of activity that gives you similar types of emotions and experiences, leave a comment below or send me an email. I’d love to hear from you!

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From Baby to Toddler: First Birthday and First Anniversary of Birthing

MILESTONES VS ANNIVERSARIES

Milestones are typically cumulative: one leads to the next and to the next, either in number (as with birthdays) or in skill level (as with motor development). Anniversaries, on the other hand, are a remembering of a singular event. Milestones feel like an accomplishment, a moving forward. Anniversaries feel like pausing and looking back, to see how far we’ve come.

The first birthday of my child was a strange mix of both. Their first birthday: a huge milestone, and hopefully the first of many birthdays to come. The one-year anniversary of their birth: this time last year I was in labour for four days, having an experience unlike any other in my life.

The birthday celebration feels very external – it’s about the baby, how much they’ve changed and grown in one year (so much!) and celebrating with family. The anniversary of birthing feels very internal and personal. It’s an experience I went through with my husband that we have only shared with a couple people.

So how are you supposed to celebrate these two highly interconnected experiences that are so wildly different?

FIRST BIRTHDAY: IS IT REALLY THAT IMPORTANT?

For most birthdays, it’s all about the person who’s birthday it is. But for a child’s first birthday, they don’t really understand what’s happening, don’t have any expectations of what a birthday is, and won’t be disappointed if it is skipped altogether. So why bother with all the fuss?

For the parents of course! Getting through the first year of your child’s life is a huge accomplishment. Whether it felt easy or hard, take this excuse to celebrate!

We initially didn’t really care about having a party. Everyone was busy, I was navigating the end of parental leave and returning to work, and our kid was just starting daycare and was exhausted. But we knew we would feel disappointed if we didn’t. So we made it work. We had a small family gathering outdoors and our baby got to try cake for the first time. It was nothing extravagent but it was definitely important.

Our baby is now officially a toddler (but that doesn’t mean I’m going to stop calling them my baby).

REMEMBERING THE BIRTHING PROCESS

In the days leading up to my baby’s first birthday, I was tracking what was happening the year before. A year ago at this time I was just starting labour. A year ago at this time we were talking to the midwife for the second day in a row. A year ago at this time things were getting pretty intense and I was already exhausted. A year ago at this time we were heading to the hospital. A year ago at this time we were holding our baby for the first time.

I had a long slow labour. This remembering, therefore, spans the three days prior to my baby’s birthday as well as the birthday itself. At the same time as wanting to remember these experiences, life was continuing on. I was at work one of those days. We were doing two hour daycare visits on two of those days. My husband was working for three of those days and we didn’t have much time to reminisce together. So sometimes, something important had happened the year prior, but the moment had already passed by the time I had the awareness to remember.

It felt like I was doing the experience and myself a disservice by missing these key moments. But really, no one around me knew or cared. It was just for myself and therefore I can decide how and when I remember them. Not remembering them at that exact moment a year later doesn’t mean they didn’t happen, that I’ve forgotten about them, or that I’m ignoring the impact they had. It just means that it was one experience, a moment in time, and I am continuing to live my life beyond that moment.

I definitely want to find a way to commemorate this experience more concretely next year. I want to include my husband, and potentially even my child, in my remembering process. I want to build a tradition.

BUILDING TRADITIONS

Traditions are important. They are used to mark milestones (such as having a birthday celebration) and anniversaries (such as going on a date or exchanging gifts on your wedding anniversary). Because of this, a tradition can tie these two wildly different connected experiences toogether.

For me, a tradition around my birthing experience would involve some recognition of the intensity and endurance involved in that experience. It would be a remembering and celebrating of what my body was and is capable of and the role my husband played in supporting me through that process. This year, I did this mostly on my own, internally, with a bit of sharing with my husband.

A tradition around my child’s birthday would be pretty typical – the cake and candles, the presents, and the family gathering. I also want to include a reflection on the past year – some of my child’s, and our family’s, important experiences, challenges, and achievements. This year, we had a family party with cake (no candles because fire and one-year-olds is a dangerous combination), and my husband and I did a quiet re-reading of our monthly baby journal entries and a look back through our pictures and videos.

One way we could combine these experiences in the future is with a candle. I would light the candle on the anniversary of when my labour started, each of the next few evenings we would share some memories of the labour experience and the past year of our child’s life, and on their birthday we would light the candles on their birthday cake (or cupcake if the actual party is on a different day) using the same candle. My labour candle lights my child’s birthday candles. It has the symbolism and recognition I’m looking for.

Maybe next year I’ll write another post describing what we actually end up doing. Until then, let me know what your experience of your child’s first birthday was. How do you comemorate your labour and birthing experience?

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From Baby to Toddler: The End of Parental Leave and Start of Daycare

In Canada, where I live, we have a year long parental leave. It was amazing to get to spend the majority of my time with my baby for their entire first year of life. This is the time we lay the groundwork for the bond we will have from then on.

Life took on a completely different pattern when I was on parental leave. It had a narrow focus that required me to develop a wide range of new skills. It felt like my ‘normal’ life was put on pause for a year while I did this new ‘caring for my baby’ thing. It was like stepping sideways onto a completely different track of my life. The weird part was not knowing how these two tracks would merge at the end of the year.

PARENTAL LEAVE IN A PANDEMIC

Parental leave can feel isolating – you are away from all your work related friends, spending most of your time at home caring the your new baby. The friends you used to hang out with may or may not be interested in hanging out with you and your baby. You may find those friends are no longer the type of support you need. Or you no longer seem to have much in common now that your focus has shifted. At times being on leave with a new baby did feel isolating. But, being an introvert, I think it didn’t bother me as much as it would some people.

My parental leave overlapped entirely with the global COVID-19 pandemic. This meant that everyone, not just me, was feeling isolated. As a result, I felt less alone in the experience. There was lots of media attention given to the emotional effects of isolation and the development of internet based communication systems. Many social groups were adapted to online platforms. This gave me access to support networks that I would not have had otherwise. Many of these were local groups in the US that I could now access over zoom.

So, overall, despite the general isolation of being at home with a baby, reinforced by the pandemic, I ended up feeling less isolated than I would have otherwise. But the contact I had was with a completely different set of people than those in my previous life. So when my leave finished and I went back to work, very few people had seen or heard from me in a year. And everyone wanted to know how my baby and I were doing.

REINTEGRATING WITH THE WORLD

The end of parental leave is like pushing our way out of our family cocoon (reinforced by the pandemic-induced isolation) and re-entering the world, now as a family of three. Or, to continue with the same metaphor as above, it feels like trying to merge two tracks that are wildly different. It feels vulnerable and shaky.

Some of this shakiness is logistical – we can no longer simply get ready for work and leave, come home and make dinner, hang out and go to bed. One of us has to get our kid ready for their day and feed them, drop our kid off at daycare, pick them up, and then do all the things in the evening we’ve been doing the past year. In this way, the tracks don’t so much merge as we shift back and forth between them throughout the day – the family/childcare track and the work track. These compenents are easy to predict and plan in advance, even if they feel a bit overwhelming at the start.

The parts that are more shaky are how our family is perceived and how to be as authentic as possible without spending more energy than we have. How to manage the impact of attending daycare (more on this below). How to stay focused on our non-baby related tasks when we’ve been so used to focusing the majority of our attention and time on our baby. These are the more nebulous emotional things that we will have to navigate or learn as we go.

Reintegrating with the world is also socially overwhelming. I went from having limited social contact, especially with the pandemic, to seeing all my work colleagues again. I was answering the same questions over and over. Inevitably, one of those questions was ‘remind me again, did you have a boy or a girl?’ I know it’s just small talk and people wanting to connect but it throws all the societal assumptions about gender that I’ve been happily avoiding this past year in my face.

I have to re-learn how to let the dysphoria enducing comments and situations roll of my back and leave the irritation from these situations at work as much as possible. Having a fun, cute baby to come home to definitely helps.

STARTING DAYCARE

After spending almost every day together, having my baby spend five of seven days at daycare feels like there will be monumental distance between us. I feel like I will miss important steps in their development. Or miss enough of the little incremental developments so that when they show a new skill or level of understanding, it will come as a surprise. It will feel sudden. I will feel like they are growing too fast for me to keep up.

Maybe this is true. But maybe, if I spend dedicated play time with them during the times we do spend together (early mornings, evenings, and weekends), it will be enough time to see these small shifts. It’s not like they’ll be at daycare 24/7 afterall.

So far, our daycare experience has gone well. We found a daycare we were comfortable with that had a spot available when we needed it. We did a couple two hour visits to get my child familiar with the environment and staff while still having me as a safety net. On the second visit I left for an hour which did not phase my child in the least.

In the first full days of daycare, we dropped them off as late in the morning as we could and picked them up as early as our work schedules would allow. Even with these shortened days, our baby was exhausted. They have been napping on the way to daycare and after coming home in addition to the midday nap they get at daycare. As long as we give them these times to sleep, they seem to be doing ok.

My baby is definitely aware of spending less time with us. They need a lot more time being held, especially in the morning and after naps. They dislike spending as much time as they used to in the stroller or carseat where they can’t see or interact with us (though this could also be related to their increasing independence). Since I also need more cuddle time with my baby, so far I am ok with this.

BALANCING RISK AND REWARD

When we first decided daycare was the best option, we weighed the pros and cons of each option available to us. But just because we settled on full time daycare doesn’t mean we don’t have to continue to be aware of the risks and rewards. Knowing the risks will help us mitigate them or adjust for them. Knowing the rewards will help us get the most benefit from it. So here are a few of the risks and rewards we are noticing:

Risks associated with daycare

  • COVID exposure risk – no masks, lots of adults and kids in a small space (we wear masks any time we go in)
  • Considerably less bonding time
  • Less control over our child’s schedule to give them what they need (mostly in terms of sleep)
  • Financial risk due to high cost

Rewards associated with daycare

  • Exposure to more germs leads to a stronger immune system
  • Socialization
  • More guided activities and resources
  • More personal freedom for work/school

How do our experiences reintegrating with the world and starting daycare compare to yours? I imagine if you are in a country that only has six weeks of paid parental leave and you had to return to work at that time your experiences would be wildly different. Please share in the comments below!

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How to be a Trans Inclusive Health Care Professional

THIS IS IMPORTANT AND YOU CAN HELP!

Trans people experience a wide range of barriers to health care including overt discrimination, uninformed health care professionals, systemic discrimination, and personal biases. As a result, trans people frequently have negative experiences in health care settings and often avoid accessing health care services even when it is necessary. Ultimately, this leads to significant health disparity. This is compounded by having intersectional identities and experiences that also experience health care bias (fatness, racial minorities, disabilities, neurodivergence, sex workers, previous incarceration, current or past drug use, etc.)

Trans people have a significantly higher risk of suicide, especially youth. The single biggest protective factor against this increased risk is having supportive people in their life that respect their name and pronouns. That’s all it takes (though the more support the better of course).

So as a health care professional, what can you do to help? Here are some suggestions.

DON’T ASSUME

Don’t assume you know someone’s gender. Not based on their legal gender marker, their presentation, their body shape, their voice, their experiences, or the clinical service they are accessing. Trans men can be pregnant, birth, and body feed their children. Trans women can have a low voice. Nonbinary people come in all shapes, sizes, and presentations. Not every trans person is able to or cares to change their gender marker.

Don’t assume someone’s pronouns or the language they prefer based on their gender (or any of the other above information). People can use any pronoun regardless of their global gender identity. Pronoun preference can shift day to day, depending on context, or depending on the people they’re with. Other gendered terms are separate from pronouns. People can prefer seemingly conflicting terms (such as preferring Mx., sir, guy, sister, and Mom) and this is perfectly fine.

Don’t assume a trans person’s transition trajectory. Don’t assume every trans person wants to transition in any way, what components they will want to include in their transition, or what order or length of time they will take to access and engage with the options available to them. There are not only two pathways for transitioning. There is no set end point to transitioning. It is a highly variable and individual process that spans many many years if not the rest of their life.

So if you’re not supposed to assume any of these things, how do you find them out so you can interact respectfully and provide the appropriate care? You use neutral language for everyone (not just the people you suspect of being trans) until they specify or until you confirm by asking specific questions. Knowing what questions to ask and how to ask them in a specific and respectful way comes with practice. It is your choice whether you want to practice on your own time (via accessing formal training opportunities or informally interacting with trans people on a personal level) or over the course of your professional career.

RESPECT NAMES, PRONOUNS, AND GENDER IDENTITIES

You don’t have to understand every gender identity in order to respect them.

When you get someone’s name or pronouns wrong (which you will, we all slip up sometimes), correct yourself and move on. Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

This goes for documentation and patient records as well. Find a way to include preferred names, pronouns, and other important language in your patient demographics tracking system. Document using the patient’s preferred name and pronouns. If these don’t match their legal information, start with a note that states that you will be referring to [legal name] as [preferred name] and using [preferred pronouns] for the remainder of the patient’s chart. If you have to do this at the beginning of every chart note, then do it. It’s important.

IT IS YOUR JOB AS A PROFESSIONAL TO BE OR BECOME INFORMED

It is not your patient’s job to educate you on the basics of trans identities, trans health care, trans bodies, or how to respectfully interact with them.

It is your job to know what aspects of trans experiences and medical care relate to your scope of practice. If you are a medical doctor and do not understand that trans men do not need prostate exams and trans women do not need pap smears, you have a significant amount of learning to do to be considered a competent medical professional (for anyone, not just trans people).

‘I was never taught that in school’ is never a good reason not to know something. All regulated medical professions have an expectation of continued learning and keeping up with medical advances and new research. Would you prescribe someone the same medication now that you did twenty years ago even if it was no longer recommended and newer medications that are cheaper, more effective, and with fewer side effects had since been developed? No? Then don’t treat a trans person according to twenty year old ‘best practice’ guidelines. Those are no longer best practice. The world of trans care is changing rapidly. It is your job as a professional to stay up to date.

YOU DON’T NEED TO KNOW EVERYTHING TO BE A GOOD HEALTH CARE PROFESSIONAL

Even if you are doing your best to stay informed, there will be times when you’re not sure whether you’re missing something or whether their experiences as a trans person simply aren’t relevant. You don’t need to know everything. But…

You need to be willing to admit when you don’t know something.

You need to do the work to learn what you need to know when you identify a gap in your understanding or knowledge.

And you need to be able to find the information you need and assess whether the source is reputable, scientifically based, and whether it holds bias (hint: there is always some bias if it is a scientific source so it’s important to be aware of it).

TRUST THE PATIENT

Trans people’s experiences are incredibly nuanced, intersectional, and often very internal. You cannot judge what a trans person (or anyone, really) is struggling with internally by looking at them. Therefore, you cannot judge what care would be best without first understanding and accepting what they are telling you about their experiences, struggles, joys, and desires.

It is your patient’s job to be as honest with you as they think is safe and necessary in order access the care they need. Sometimes this involves misrepresenting their identity or hiding parts of their medical history. The more informed you are and the more respectful you are, the more likely your patient will trust you, the more honest they are likely to be with you, and the better the care you can provide.

Don’t question their lived experience because it is outside your area of experience or expectation. Trans people are not exaggerating when they describe the systemic barriers they face such as long wait times, repetitive updates and submissions of forms, lack of appropriate processes for changing legal documentation, etc. You can be shocked and disgusted that that is the way the system is but unless you have your own lived experience of navigating these barriers with a trans person and have found a way around or through them, you have no right to argue against them, suggest that they are doing something wrong, or simply haven’t tried hard enough.

TRANS PATIENTS ARE STILL PATIENTS

At the end of the day, trans patients are still patients. If you’re not sure how to proceed, draw on your clinical knowledge and treat the patient in front of you, not the trans patient you are assuming they are.

Don’t know whether the testosterone that a trans patient is taking may be relevant to the reason you are seeing them? Go back to the basics. What affects does testosterone have on a human body? What body systems might it affect? Are these relevant to your patient’s current concerns? You can follow a similar thought process for any component of trans experience or medical care.

If you think something might be relevant, explain your reasoning to the patient in terms they would understand and ask some clarifying questions. If you’re still not sure, make a note of it and move on to the next part of your assessment. Then, before you see the patient for their next visit, learn more about it.

As with any patient, consider the whole health of the patient, mental health included. If there is a component of their trans identity or trans specific medical care that you are worried is causing concern for other aspects of their health, consider ALL the consequences of interrupting that behaviour or medical care before making a recommendation.

Often, trans people have to compromise their physical health and wellbeing in order to protect or maintain their mental health and wellbeing enough to function in society. If you then suggest that they change their behaviour in order to protect or improve their physical health, that change could cause significant damage to their mental and emotional health (which is much harder to get help with and recover from). So, before making any recommendations, ensure that you understand the patient’s reasons for engaging in that behaviour or pursuing that avenue of medical care. You may not be seeing the big picture, or your version of the big picture might be different from your patient’s.

WHERE TO GO FROM HERE

I hope this has helped clarify a few things and point you in the right direction. Simply by reading this, you are already showing you are a better health professional to trans people than the majority. That is how low the bar is. Please help raise it.

Below you will find recommended resources. These are a place to start, not a sum total of what you need to know. If these links are outdated or broken, please let me know. I will try to keep it up to date. But again, if you are a health professional, you have the skills to find these resources on your own.

Beyond these links, how are you supposed to learn more about trans people (or other minority groups that differ from your experience)? Here are a few options:

  • Talk to a trusted friend or family member who is trans (or other minority) outside of a professional-patient relationship
  • Read descriptions of trans experiences written by trans people (such as this blog)
  • Attend a lecture or other learning opportunity presented by a trans person
  • Pay a trans person to provide education to you and your staff or assess your clinic/practice on the basis of trans inclusion

Reach out if you are struggling to find specific resources. If you are a trans person and would like to add suggestions to this post for how health professionals can be trans inclusive, please leave a comment!! The more experiences and voices the better.

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How to Manage Stress and Prevent Burnout Part 2

If you started with Part 1, you’ll already be familiar with my blue-yellow-green-yellow-red stress state system, what each state feels like to you, and have a variety of factors you can use to identify your stress state. If you’ve been tracking your state since last week, you may have already noticed some patterns in how your stress state fluctuates over the course of a day or week.

The next step is to identify what is making your stress state move away from the green zone (triggers) and what you can do to bring it back towards the green zone (relievers). Then we’ll put everything together to build a routine where you manage the stress you accumulate as it happens and keep yourself in the green zone as much as possible.

TRIGGERS

Triggers are anything we find stressful. Anything that changes our stress state in a direction away from the green zone.

Some are obvious – the ones that have already come to mind as you read this. Others you’ll have to discover by observing fluctuations in your stress state and looking for the cause.

Some are predictable and consistent – these are the easier ones to manage. Others are spontaneous or fluctuating in intensity and will take extra time, awareness, or effort to manage.

Types

There are lots of different types of triggers. The things that trigger a stress response in you is completely individual and valid. Here are some examples (but this is by no means an exhaustive list):

  • Personal
    • Health fluctuations, physiological stresses, pain
    • Security (income, house, car, work, finances)
    • Dysphoria
    • Addiction
    • Reminder of past trauma or loss
  • Interpersonal
    • Abuse, threats, violence
    • Discrimination
    • Worry or care for a loved one
    • Expectations
    • Deadlines
    • Tension in a relationship, broken trust
    • Loss
  • Societal
    • Political unrest or discrimination
    • Systemic discrimination
    • Sensationalist news cycle
    • Pandemics/natural disasters

This list is just to get you started and give you some ideas of where to look. Not all of these will be sources of stress for you and there are likely other things that are triggers for you that are not on this list. You can keep adding and removing triggers from this list as things change in your life. For now, let’s take the list you have and fill in some practical details for each one.

Effects

Some triggers have a consistent and specific effect on your stress state. For example, some triggers will always push you towards the red zone while others will always push you towards the blue zone. If you notice any triggers like this in your list, make a note of it.

Most of your triggers will have a more general effect of moving you away from the green zone in either direction. Which direction your stress state moves is not always predictable since we are complex organisms living in a complex societal system. We are not trying to create an equation or predictive model, simply look for patterns.

Intensity

Different triggers will have different magnitude of effect. Some cause a small amount of stress and might move you from green to yellow or yellow to red/blue (one step). Some cause a moderate amount of stress and could move you from green straight to red/blue or from yellow straight to black (two steps). Some may cause so much stress that you would immediately shut down or dissociate i.e. move from green straight to black (three steps).

Consider each trigger on your list and assign it a number value from 1 to 3. You can add a 0.5 value if there are some low level triggers that wouldn’t even move you a whole stress level. Or you can use whatever number system works for you (1-5, 1-10). Try to keep it as simple as possible. We want to be able to easily relate it to the fluctuations in our stress state and, as you’ll see in the next section, use the same system for our stress relievers.

Let’s take a look at those now.

RELIEVERS

Relievers are anything that decreases your stress level or shifts your stress state towards the green zone. These are not things that get rid of the cause of the stress (the trigger or stressor). They are activities that reduce the stress load on our system by helping us process or decrease the effects of the stress.

Types

As with triggers, there are lots of different types of relievers. I have grouped them into categories that I find practical.

  • Positive Interaction
    • A long hug
    • Intimate time with my partner
    • Positive social time with a small group
    • Exercising compassion by doing something nice for someone
  • Moving Your Body
    • Running or other cardiovascular exercise
    • Hiking or fast paced walking
    • Dance
    • Strength training
  • System Regulation
    • Deep breathing
    • Meditation
    • Yoga, stretching, Tai Chi, Qigong
    • Relaxation
    • Reading
  • Creative Expression
    • Creative writing
    • Art
    • Crocheting, sewing, or other fiber crafts
    • Singing or playing music
  • Productive Processing Time
    • Journaling
    • Therapy
    • Letting my mind puzzle through things, find connections, or clean up the mental clutter while doing housework, having a shower, or other mundane task
    • Doing a mundane task while staying focused on the positive effect I am having or the gratitude I have towards that aspect of my life

Some of these will occur over the natural course of your day. Some you will have to find time to engage in.

Effects

Some relievers will have a stronger effect towards relieving stress from specific sources. For example, I find exercise to be particularly helpful for acute triggers like an interpersonal interaction where I experienced discrimination and creative expression to be particularly helpful for chronic low level triggers like dysphoria, systemic discrimination, and typical daily stress.

Some relievers will have a stronger effect when you are in a specific stress state. For example, I find system regulation relievers to be more helpful when I am in the yellow to red zones and positive interactions when I am in the yellow to blue zones.

Some relievers will be effective no matter what stress state you’re in or what the trigger was. For me, this is productive processing time.

If you notice any of these specific effects, make note of them next to the relievers in your list.

Intensity

As with triggers, each reliever will have a stronger or lesser effect. Some will bring you one level closer to green, some will move you two levels closer to green. However, in my experience, triggers tend to be better at moving us away from the green zone than relievers are at restoring us to our green zone. So if you used the 1-3 scoring system for triggers, it’s likely that you’ll be using 0.5 or even 0.25 for some of your relievers. Even though it seems like an activity that relieves so little stress wouldn’t even be worth doing, it is important to have these relievers in your list. You’ll see why in a second.

Energy Cost

This is a really important aspect of relievers to consider. How much energy does it take for you to initiate or complete each relieving activity? You can use a number system again (1-3, 1-5, or 1-10) or a traffic light system (red for hard, yellow for moderate, green for easy), or any other system that makes sense to you.

The important thing is to know which activities you can do with little to no energy reserve, which ones will take a bit more energy, and which ones will take considerable energy. This shows you which ones to engage in when you’re in an extremely burnt out state (black), which ones you can manage in a moderately stressed state (red/blue) or slightly stressed state (yellow), and which ones you’ll only be able to engage in when you’re at your best (green).

For the most part, I have found that the higher the energy cost, the greater the intensity of the effect on my stress level. This means that the low cost relievers have the smallest effects. But sometimes, if that’s all I can manage, that is where I have to start. Don’t forget these effects are cumulative. Four easy stress relieving activities can bring me out of the black zone and back into blue/red. I then have enough energy to engage in slightly higher cost activities that have a stronger effect.

Now that you know all about your triggers and relievers, let’s design a practical strategy for managing your stress level and keeping you in the green zone.

PUTTING IT ALL TOGETHER

So far, you have:

  • Identified your stress states and described them using physical, mental, and emotional cues
  • Identified patterns in how your stress state fluctuates throughout the day or week
  • Identified your triggers, how they affect your stress state, and how intense that effect is
  • Identified your relievers, what types of triggers or stress states they are useful for, how intense the effect is, and how much energy they cost

Now you will learn how to use this information on a daily basis to manage your stress as you accumulate it. The goal is to develop a routine that is sustainable and helps keep you in the green zone. That way, when you encounter unexpected triggers or routine triggers are suddenly more intense, you have a buffer before you end up in the black zone and you have the energy reserve to engage in the most effective relievers.

Here is one example of a daily practice you can follow:

  1. Monitor your stress state (as discussed in Part 1)
  2. Make note of the triggers you encounter – type, effect, intensity
  3. Make note of the relievers you engage in – type, intensity
  4. Determine amount and type of unresolved stress
  5. Engage in appropriate and manageable relieving activities

You will see a pattern of typical triggers you encounter and typical relievers you engage in. If your day to day activities are sustainable and allow you to stay in the green zone, you will find you are engaging in enough relievers to match or outweigh the amount of stress generated by the triggers.

If your day to day activities are slowly leading you towards burnout (or other black zone state), you will find that your typical daily relievers are not sufficient to counteract the stress generated by your triggers. Are there triggers you can do a better job of avoiding or resolve altogether? Are there relievers that would be more effective that can replace the ones you are currently using? Are there relievers you can add to your routine that would be low cost or ones you can do while doing other things?

After a few weeks of assessing your stress state and the balance of triggers and relievers, you will figure out which relievers work easily into your schedule to most effectively balance the majority of the stress from your triggers. But at some point, you will encounter one of those spontaneous triggers, one that was suddenly at a much higher intensity, or a seemingly unending stream of small triggers that add stress faster than you can deal with it. This is when you’ll need to add something to your routine.

Determine which relievers you have the energy to engage in and of those, which would be the most effective based on the type of trigger or the stress state you are in. If you’ve been doing a good job of relieving your daily stress as it happens, you will be starting from a fairly stable place and it will not take nearly as much work to return to your green zone.

You can add extra relieving activities to your schedule a couple times a week to process any extra stress beyond your typical that you accumulate from those unpredictable triggers. If your stress is well managed on those days, these become bonus green-zone-reinforcing activities!

I hope this set of emotional processing and stress management posts has helped you! If you have questions, need clarification, or simply need a sounding board to work through some of these steps, don’t hesitate to reach out. You can send me an email or comment on a post.

If you have a different way to process big emotions or manage ongoing stress, I’d love to hear it! Please send me an email or comment below! My strategies won’t work for everyone. Maybe yours will be the strategy someone is looking for!

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How to Manage Stress and Prevent Burnout Part 1

In an ideal world, stressors would be concrete and transient – easy to identify and able to be processed to the point of relief. But in the real world, there are a lot of stressors that are nebulous and persistent. It’s hard to relieve your stress when you can’t identify or get rid of the source.

But that doesn’t mean you should ignore it. The stress is still there whether you acknowledge it or not. It is still affecting your hormones, behaviour, emotions, and brain function. It builds up and builds up until you are forced to remove yourself from contact with the stressor via sickness, burnout, addiction, or breakdown. While stress is not always the cause of these states, in my experience, unmanaged stress will inevitably lead to these states or something similar.

I have struggled with burnout for a number of years. During this time I have developed and refined a strategy for monitoring my level of stress and taking daily action to relieve as much of it as I can to prevent it from building up and causing burnout. In this post I’ll talk you through the monitoring component. In Part 2, we’ll work through the managing process.

You may be able to process and resolve some of the areas of emotional stress in your life. I have a different system for this which I talk about in two posts: How to Work Through Areas of Emotional Stress Part 1 and Part 2. The more areas of stress you resolve, the less stress you have to manage on an ongoing basis. And being good at managing your stress will help you stay as happy and content as you can while you’re working on cleaning up as much of your emotional chaos as possible. Both processing and managing stress are important. You can start with either one. The important thing is to put in consistent effort until it becomes automatic.

STRESS ZONES

The first step towards managing your stress is to identify what your different stress states feel like to you. I colour coded my stress states as follows:

Green: good, happy, relaxed, calm, confident, optimal, not stressed at all.

Red: anxious, irritable, angry, chaotic, antsy, hyper, spazzy, fight or flight.

Blue: tired, heavy, sad, numb, scared, avoidant, fatigued, freeze or flight.

These three states (what I think of as neutral – green, high – red, and low – blue) are the easiest to identify. But you don’t want to wait until you are all the way in the red or blue zones to recognize a shift in your stress level. So I include yellow zones – one between green and red, and one between green and blue. I also added a black zone beyond red and blue to indicate that spending too much time in either of those states will lead to burnout or sickness (or whatever your system shutdown mode is).

I laid out my page from top to bottom as follows: black, red, yellow, green, yellow, blue, black.

Now you are going to add as much detail for how those states feel like to you as you can. We are going to use three different indicators: physical, mental, and emotional. For each of these, start with whatever colour is easiest for you to fill in (typically green, red, and blue). Move on to the harder ones (typically the yellow zones). If you’re not sure what to put in the yellow zones, write down a gentler version of what you have in the red or blue zone. For example, if you put angry in red, maybe put frustrated in yellow, or if you put fatigued in blue, put tired in yellow. Don’t worry about filling in black – your system will tell you when you’ve hit that level whether you know what it feels like or not.

Let’s go through each of these indicators separately.

Physical

How does your body feel when you’re in that state?

How much energy do you have? Do you tend to sleep more or less than your average?

Do you have increased muscle tension or heaviness and fatigue? Does your body feel hot, cold, tingly, or numb? Where in your body do you feel these sensations?

Does your appetite change? Do you feel nauseous, queasy, or hungry?

Do you feel dizzy or lightheaded? Do you get headaches, body aches, or other types of pain?

How does your breathing feel? Is it faster or slower, deeper or shallower? Do you breathe more with your chest and shoulders or your belly?

How does your heartrate feel? Is it faster, slower, or erratic?

Mental

What thoughts go through your head when you’re in that state?

What words do you use when describing a situation such as going to work or attending a family gathering when you’re in that state?

What words do you use when describing yourself when you’re in that state?

How is your ability to concentrate? Are you able to shut out external distractions? Are you able to ignore distracting thoughts and emotions?

Are your senses heightened or dulled? Are you hypersensitive to any particular stimuli?

How easy is it to learn something new? Are you able to remember things just as easily as when you are in the green zone?

How would you describe the inside of your mind? Is it chaotic, filled with static, fritzing, dark, foggy, cloudy, bright, open, constricted, porous, etc?

Emotional

What emotions do you feel most often when in this state? To make this nice and easy, refer to an emotions wheel such as this one.

Don’t be afraid to write down conflicting emotions for the same colour. Each state isn’t always triggered in the same way so we can definitely experience a range of emotions.

You may find describing one of the indicators (physical, mental, or emotional) to be significantly easier than the others. We all experience stress differently and pay attention to different stress responses. I still recommend you try to write down something for each indicator in each stress state. Sometimes when we’re calm we can most easily identify one aspect but when we’re actually in this state it’s a different aspect that is most obvious.

MONITORING YOUR STRESS STATE

Once you have a list of physical, mental, and emotional descriptors for the five stress zones, you can start using it to monitor your stress level. You can’t manage something you aren’t aware of. Set an alert on your phone to go off at regular intervals or pick a few times a day to do a quick check in. Try to pick a few times a day when you are in different environments – when you wake up, when you’re at work, when you’re with family, before bed.

You can quickly answer the above physical and mental questions and pick out three emotions on the wheel and then see which state your responses line up with or you can refer to your descriptions of the zones and do a physical, mental, and emotional check in to see where you land. Whichever way gets the most honest and accurate response without taking so much time that you won’t stick with this practice.

The goal is to get familiar with your own stress states and symptoms so that you don’t have to consciously do the check in. You will notice when your muscle tension, energy level, or breathing pattern changes. You will hear a repetitive thought in your head and know that you’ve shifted to a different zone. You’ll realize your reactions to people around you are different, indicating a new emotional state.

I recommend documenting your stress state. If you’re monitoring it, why not track it as well? You can use a pocket calendar with coloured stickers (make sure you differentiate the two yellow zones somehow), an app in your phone, a journal, or even a series of sticky notes if that’s what’s handy.

You can track your stress for a few days, a week, or longer. It’s up to you. This information will show you any consistent patterns in how your stress changes throughout your day and throughout a week. These patterns will be very helpful when we work through the second step in this process: managing stress.

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How to Work Through Areas of Emotional Stress Part 2

You will want to start with Part 1.

How is everyone doing? If you have started working through steps 1 to 3 already you might be feeling a bit emotionally vulnerable, bruised, or drained. That’s ok. It’s part of the healing process. But make sure you take care of yourself. If you push yourself too fast and don’t let your emotions settle again before tackling steps 4 to 6, you will be too overwhelmed to use your analytical skills and too vulnerable to be as honest with yourself as you need to be.

In case you missed it before, here is a blank chart you can use as a guideline to fill in as you work through the steps.

Processing-Emotional-StressDownload

Now, let’s continue on to steps 4 through 6.

4. IDENTIFY THE SOURCE OR TRIGGER FOR EACH EMOTION

This is the hardest part in terms of thinking and detective work. The goal is to answer the question “Why do I feel this way?” for each negative emotion that you listed in step 3. Some examples of sources or triggers for emotions are:

  • Beliefs held by others close to you or society as a whole
  • Formative experiences
  • Influences of people who had an impact on you
  • Physiological factors
  • Dysphoria
  • Your own actions
  • Personal values or priorities
  • Personal beliefs or attitudes

Sometimes you need to work backwards a few steps. For example:

  1. Area of stress – feeling like I’m not a good parent
  2. Aspect of control – belief;
  3. Emotion – inadequate;
  4. Why? Because I can’t lift my kid due to pain (physiological factor). Why does not being able to lift my child due to pain make me feel inadequate? Because I have an expectation that in order to be a good parent I need to be able to lift my child when they ask to be picked up (personal belief). Why do I feel like being a good parent requires lifting my child? Because that is the model of parenting I am exposed to by society (belief of society – ableism).

Result: I am affected by the belief that I am not a good parent which makes me feel inadequate because society tells me I should be able to lift my kid when they ask to be lifted and I can’t always do that because of pain.

This process takes time. You have to sit with each answer to the why question for a little while to see if your mind is still searching or if that resonates with you as being the root cause. I have found that talking to a trusted friend or family member is very helpful at this stage. They often have similar experiences or insight into my own beliefs, thoughts, experiences, feelings, and actions.

During this process you may uncover a new influential or formative experience from your past that is the root cause of the area of stress you originally listed in step one. You can either work through this area of stress again by starting with the newly discovered cause or you can list this experience as a separate area of stress and work through it at another time.

Sometimes the root cause of an emotion is something that is within our control (matches something we wrote in step two) and sometimes it’s not. When it is, we can be reluctant to accept that this is true because it would mean we are responsible for some of the emotional distress we have been feeling. But be honest with yourself and fear not! The next step will help you use this hard-won accountability to your advantage.

5. TAKE ACTION

By now you have separated out your different areas of stress, identified what aspects you have control over, experienced the emotions that are triggered, and discovered the root cause of those emotions. Now you are going to decide what actions to take.

The purpose of taking action is to interrupt the link between the root cause (step 4) and the negative emotion (step 3). We can only act on things that are within our control (step 2) so for each emotion that you want to disrupt, you have to identify which link closest to the root cause is in your control and choose an action that will address that. Using the example from step 4, the root cause (societal ableism) is not within my control so I would back up to the link before (personal belief) and target that with an action plan.

Some examples of actions are:

  • Reframe the experience or adjust your beliefs through journaling, art, or a list of affirmations
  • Change your behaviour or adopt a new habit
  • Re-evaluate your priorities and values
  • Seek out community, connection, or support
  • Channel your personal experiences and strong emotions into advocacy
  • Talk about your experience or struggle and embrace the vulnerability
  • Confront negative influences
  • Set or re-set personal, emotional, or relationship boundaries

Be creative. Take actions that resonate with you and will help support you. Avoid actions that will drain you further or take more time, money, or willpower than you can give. You may be able to find an action that will break more than one cause-emotion chain.

Take small steps. No action is too small but most actions that you come up with initially will be too big.

Set short term goals (hour, day, week at most). Our brains are constantly measuring the distance to our goal, how much progress we are making, and how much effort it is taking to achieve that progress. If progress slows down too much or takes too much effort, our brain automatically shifts into stress mode (which we are clearly trying to avoid) or flight mode (I don’t actually care about this goal anyway, I’m fine). This is such a common occurrence for us that we are pretty terrible at noticing when it is happening. Thus, the reason for step six.

6. REVIEW YOUR PROGRESS

Don’t leave this step for too long! When you are working through hard stuff to get out of a stressful emotional loop, a month can feel like eternity unless you can tell you’re making progress. At the same time, this process can be so emotionally intense that you need to dedicate a week to working out the root cause of each emotion for one area of stress.

So pick a timeline that works for you – two weeks, a month, three months. I would say six months is too long no matter how slowly you have to work through your areas of stress.

You can start your timer from when you initiate your action plan or from when you started with step one. It depends if you are reviewing your progress with one specific area of stress or the whole process for all areas of your life. You can set different review periods for both of these if you’d like.

When the time to review comes up, look back through your notes from step one through to step five. Do they all still resonate with you? Have the emotions that you experience when you replay the event or delve into that area of your life changed? Do you have new insights into the root causes or triggers for those emotions? How have you done with following through on your action plan? Did the actions you took help the way you wanted them to or do you want to try something else?

If a lot of the stress from an area has resolved, try working through the steps again as though it is the first time. If there are aspects you still need to work on, this will make those clear. If you’re happy with how well it has resolved, consider that area of stress complete!

WHAT IF THE CAUSE OF THE STRESS IS ONGOING OR OUT OF MY CONTROL?

Not all areas of stress can be resolved by processing them. Sometimes we process the parts we have control over (challenging our negative beliefs, adjusting our priorities, finding community and support) and it is still a moderately high source of stress.

I have a different system for managing stress that I share in another two part series: How to Manage Stress and Prevent Burnout Part 1 and Part 2. It is visual, practical, and straightforward. There are lots of ways you can adapt it to create something that will work for you.

As always, reach out if you need to.

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How to Work Through Areas of Emotional Stress Part 1

My experiences have taught me how to work through intense situations and process emotions so that I’m not holding on to negative sources of stress and being influenced by them in ways I don’t like or can’t control. I wanted to share my strategy in the hopes that it will help you do the same.

This process is based on the belief that we can, for the most part, control what is in our own heads and are responsible for our own emotions. We can absolutely be manipulated, traumatized, abused, gaslit, or have a chemical/hormonal imbalance but my hope is that working through this process will help separate the manipulation and influence of others or physiological causes from what is genuine to ourselves and under our control.

This process has six steps:

  1. List areas of emotional stress
  2. Identify which aspects are within your control
  3. List the emotions
  4. Identify the source or trigger for each emotion
  5. Take action
  6. Review your progress

In this post, I will explain steps 1 to 3. In Part 2 I will cover steps 4 to 6.

Here is a document containing a blank chart that you can use as a guideline to fill in.

Processing-Emotional-StressDownload

Now, let’s look at the first three steps in detail.

1. LIST AREAS OF EMOTIONAL STRESS

What takes up space in the back of your mind that nags at you, wears down your emotions, or takes energy to keep it pushed to the back of your mind? When you’re having a day where you are stressed, tired, irritable, numb, or teary, what negative things does your brain say to you? What aspects of your life make you feel stressed when you are forced to think about or focus on them?

These can be a variety of things:

  • Past experiences that were traumatic, difficult, or had a lasting negative impact on you
  • Negative beliefs about yourself
  • Broken relationships
  • Components of your life that feel like a constant struggle
  • A future event (though this is often causing stress because of a present or past situation or belief)

Still not sure what is specifically bothering you? Think through each area of your life: health, work/vocation, relationships, childhood, finances/security, identity, or anything else that is important to you. Do you frown, feel your body tense, or experience a negative emotion when you think about that area of your life? It’s a good bet that one area of stress relates to that area. Break that area of your life down into smaller pieces if you can and watch for the same reaction. The more specific you can be the better.

2. IDENTIFY WHICH ASPECTS ARE WITHIN YOUR CONTROL

Often when something happens to us we feel like we have no control over the situation or event. This naturally leads to the belief that we have no control over the outcome or effects of the event. In my experience, this is not true. We always have control over SOME components of how a situation is affecting us presently. For example:

  • Our current actions
  • Our current beliefs and attitudes
  • Our ability and willingness to adapt
  • Our willingness to seek out and accept support

Be honest with yourself. This isn’t about figuring out the truth of a past event. This is about identifying how that past event is currently affecting you and what parts of that effect are under your control. What you learn from this step will be important for building a useful action plan in step 5.

3. LIST THE EMOTIONS

This is the hardest part emotionally. You might want to pick one area of stress to focus on and continue from step 3 to 6 with that one area before you process another one to avoid being overwhelmed. You will likely want to work on this step in a private, safe space. I recommend having a self care plan in place in advance – when you are in emotional turmoil, what helps you regain a sense of emotional stability? Plan to engage in these activities or have a friend standing by for you to connect with as often as you need while working through this step.

The goal is to list all the emotions that are brought to the surface when you delve into each area of stress. Some ideas of how you can do this are by:

  • Replaying the experience in your head
  • Writing about that area of your life or that situation
  • Listening to the self-talk that relates to that experience or aspect of yourself
  • Talking about it with a trusted person

Don’t forget about the positive emotions! Often we focus on the negative ones and once we list the positive ones along side them we realize we have a more balanced experience than our brain has been telling us.

I recommend you refer to an emotions wheel (such as the one you can find here) to help you find appropriate words for what you are feeling. I have definitely had the experience where I feel something, or more likely many things, and it is overwhelming and difficult to find a word that describes it which leads to frustration. You can also use the emotions wheel as a prompt – work your way around the wheel thinking about each emotion separately, what that would feel like for you, and if that feeling matches something that came up while replaying or sitting with an area of stress.

If all the different areas of stress in your life seem to cause the same set of emotions or if you only seem to experience emotions from a narrow spectrum of the emotions wheel, consider the possibility that there may be an underlying physiological cause such as a neurochemical or hormonal imbalance. I am not a doctor. This observation comes from personal and second hand experience.

You are halfway there! Steps 1 to 3 are all about discovery. In Part 2 we explore steps 4 to 6 which are about analysis, action, and reflection. Take your time with this process and take care of yourself as you work through the tough stuff. I’m always here for you if you need community and support.

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