In Mindcast

Sheena Webb – Being OK With Not Being OK

Sheena Webb is a Consultant Clinical Psychologist, Service Manager and Joint Clinical Lead for the Family Drug and Alcohol Court Team, at the Tavistock and Portman NHS Foundation Trust. She speaks about what happens when we are pushed out of our comfort zone in response to distressing situations and pressures at work, and how to manage our inner critic.

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I have been hearing a lot about professionals in the public sector who are being redeployed and having to work in areas they do not normally deal with. With many people being exposed to things they had never been exposed to in their career before, like deprivation, death and like children at risk of harm. Even those who have not been redeployed are finding they are having to work in very different conditions, working outside of our normally tight guidance and governance rules. The phrase ‘We’re making it up as we go along’, comes up a lot, I’ve used it myself. 

Many of us are working outside of our comfort zone. Delivering services without the right equipment, without the benefit of face to face contact, with fewer resources and less contact with the colleagues who usually brighten our day. Some of us perhaps do not have much choice about being on the frontline, about being exposed to risks that make us anxious. Many are doing this whilst worrying about colleagues, friends or family who may be at risk or unwell and bearing the financial pressures and other losses that lockdown has brought. Some are doing this without the benefit of someone to meet up with at the end of the day, without that reassuring hug, that offer of a cup of tea. 

I wanted to talk a bit about what happens when we are pushed out of our comfort zone. In particular about what happens when we are exposed to distressing situations and pressures at work. I work in the Family Courts, and people often ask me how I cope with all of the upsetting things I see. To be honest how I respond usually depends on the day I’ve had. And this got me to thinking that the danger of giving messages to people about how to cope with difficult issues, is that it might give the idea that there is a right way to cope, that if you’re doing it right you should be coping, that coping means feeling fine and that somehow not feeling fine is not OK. What do we really mean by ‘coping’ anyway?  How do I know if I am ‘coping well’ with something?     

When I was thinking about this issue, I was reminded of a job interview, for my first job in safeguarding.  I remembering being the waiting room, and the interviewer handed me a case study and left me to prepare.  It was about an infant who had been severely injured.  There was detailed description. I felt like someone had punched me in the stomach, my heart rate shot out of control, I thought I was going to be sick.  Panic set in, the words on the page started to swim and I had the overwhelming impulse to leave. The over-riding thought in my mind was ‘I can’t do this’. In retrospect I think the only reason I stayed was that I couldn’t face that embarrassment of backing out at that point.

Ten years, and many, many sad and horrific stories later, whilst the stomach-punch panic response is not as strong, I have to be honest that the work still gets to me. In fact, I truly believe that to become immune to hearing about children being harmed, would be to lose my humanity. If I got to the point where I had no emotional response to such things, surely that would be a sign that I needed to leave. So how do I stay emotionally connected enough to stay compassionate without becoming overwhelmed by my emotions? As I say this, I notice, I’m back to this idea of a ‘right’ way of doing things. 

I still think that we collectively carry a notion that we somehow can become ‘OK’ with pain, abuse, death and loss. And we do as human beings have a tremendous natural ability to heal from both physical and psychological wounds. But often part of that healing process is about recognising the wounds, and feeling the pain. Often our natural healing processes are disrupted by being in too big a hurry to ‘be OK’, or at least, look ‘OK’. I think it’s also important to remember that healing doesn’t necessarily equate to feeling no pain. Rather it often means learning to carry on living, alongside the pain. 

The pressure to be ‘stronger’, to ‘cope better’ often triggers us into feeling even worse. I often hear people in therapy talking about how they feel others ‘cope better’, mistaking people’s outward calm as ‘better coping’.  Very often these are the very same people who are hiding their emotions from others for fear they will be seen as being weak. Enter our old friends, the inner critic and, it’s close cousin, the guilt monster. 

Many people have an inner critic, for some it’s just a nagging voice pointing out that the tablecloth isn’t straight enough, or that you really should have eaten that extra biscuit. For others, it is a relentless slave driver, beating the drum, constantly propelling you to work longer and harder, whilst always moving the finish line further and further away. 

The inner critic generally feasts on our fear that we not good enough, and our guilt monster believes that our entitlement on this earth is really only measured in what we do for others. Doing things for others is a great thing, but feeding the endlessly hungry guilt monster is a one-way road to exhaustion. And, here’s the snag, because the inner critic and the guilt monster are driven by fundamental fears about our self-worth, the more we feed them, the hungrier they get.    

When our self-critical inner voices take over, they often over-ride what your body is screaming out at you. These unforgiving voice will often tell you to carry on, be strong, don’t make excuses and never, never call in sick.  And then you find that, despite feeling exhausted, when someone asks you to do that one more thing, you mouth is saying ‘yes’, even if your body is screaming ‘no’.  In these moments we over-ride hunger, tiredness, pain and distress to our detriment. And that’s when we risk doing the real harm to ourselves.  The paradox is that our belief that it’s better to be ‘strong’, is actually what risks making us sick.     

However, the inner critic and the guilt monsters are wily creatures. Sometimes, I have actually found myself criticising myself for criticising myself. The issue is that when we try and battle with, or push these voices away, a bit like a wasp at a picnic, they kind of get more insistent. In reality, what we really need to do is let them be, but not take too much notice of them. Like a slightly irritating and judgemental relative at the dinner table.  Hear what they have to say, perhaps even give a polite response, but then let it go.   

Often, in the context of managing work stress, we hear a lot about self-care.  Taking breaks, talking to colleagues, engaging in mindfulness, eating well and sleeping well.  All of these things are immensely helpful in refuelling our tank. We know that working under stressful conditions has a cumulative impact on our bodies and we know these things are proven to be helpful.  We are literally bombarded with advice on social media about being mindful, eating well and focusing on ourselves.  

However, many people, me included, often find themselves ignoring that advice. Again, the self-critical and self-sacrificial parts of our minds tell us that that advice is for other people. That we are made of steel and we can, and therefore should, just keep going. Or, we really feel that we should follow the advice, but somehow don’t manage it, giving us another reason to beat ourselves with the criticism stick for not ‘taking care of ourselves better’. 

I’m not knocking good advice. It’s really helpful. But at the same time, it’s important to recognise why we don’t always follow that advice, and how that then makes us feel. 

An example of this is when people tell you ‘don’t take it home with you’.  Now I absolutely believe we should try and keep good boundaries between work and home. But this instruction suggests that we have some kind of water tight airlock in our minds that we can activate at the end of the working day. Now some people are great at that, but not everyone, not always. And sometimes, no matter how hard you try to detach from work, an image, a feeling, a painful detail, will follow you home. This is another moment to go easy on yourself and recognise that this happens sometimes.  That we shouldn’t feel bad about it. We should just feel human. 

Often the feeling that follows us home, is a feeling that we didn’t do enough, a worry that the person we tried to help, is still in pain or at risk.  It is really important to recognise that, however brilliant you are, there is a limit to what you can control. There is also a limit to how much you can do with the resources you have. The outcome of any situation is the result of many factors, not just how good a job we did. 

When we work in high risk or high need situations, we can feel terribly responsible for things that simply aren’t our doing. And this can be more acute when we are faced with vulnerable and distressed people. I always to say to my teams, imagine you are in A&E responding to a train crash, absolutely try your best to help people, but always remember, you didn’t cause the crash and you cannot save everybody.

Strong emotion, particularly anxiety, triggers powerful impulses to act.  When we see something terrible happen to someone else, a part of us says ‘that could you be you’, ‘that could be your child’, and activates our threat system. Our mind, detects the alarm and screams ‘do something’! The more frightening and shocking the situation, the more the force of our emotions can pull us into feeling we must act. But action is not always what is needed. Sometimes our compassion, our calm presence is more important than anything.   

So when we get home, whether the stresses of the day have followed us home or not, it’s helpful to allow ourselves the space to feel what we feel.  To let our inner critic chatter on like a radio in the background, without getting too involved. Whether we find ourselves using mindfulness, or crying, or binge watching box sets, or reorganising the fridge. To be aware that we all cope in our own ways, and the most unhelpful thing we can do is beat ourselves up for how we are coping.   

Some days are awful, and leave us feeling terrible. But if we can accept that and be kind to ourselves about it, more often than not the feelings pass. Like a plane bumping through turbulence, it can be uncomfortable and scary, but rarely dangerous. You can’t control the turbulence, all you can do is keep flying through it. And know that it’s not necessarily about flying the plane better.  You are already doing the best you can. And that is good enough.   

And if the turbulence doesn’t pass.  If you find that the awful feelings are still there the next morning, and the next and the next, if they are keeping you awake night after night, if your inner critic won’t leave you alone, if you feel numb and cannot connect with people and you feel like you are losing sight of the good in the world. Then yes, that is that time to seek more help.  And again, another time to be kind to yourself, because if you feel this way it is not your fault or failing, what you’re dealing with is just too much. As professionals we are not immune to depression and anxiety but we can often expect ourselves to be. Again, accepting how you feel without judgement, frees you up to seek the help you need. Berating yourself for not coping better, will make things much, much harder.

I hope you find some of these thoughts helpful, but if you didn’t, or if you find you can’t sit with your feelings, or you can’t ignore your inner critic, or you do agree to that extra shift, please remember, that’s OK too. 

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