It’s About Time

Hello!

I’ve been meaning to write something here for a long time, but as for many of us, this life in a pandemic that started out feeling as though it was filled with endless amounts of free time, has rapidly filled those spaces with new stressors, obligations, and other endeavors.

It seems like I’ve been talking a lot about time with my patients lately. Time, in terms of “How long will this last?” But even more often, I’m hearing concerns about individuals feeling as though they have all the time in the world, yet they’re struggling to accomplish the same types of things they did before the pandemic began.

This appears to be affecting not only those of us who are working from home but also those who are engaging in remote learning, especially college students. A lot of people are completely astonished to find that although they have nowhere to physically be, no commute, and no co-workers to drop in and give them new things to do, they’re having trouble meeting deadlines and generally staying on top of their workload.

At this point, many have identified the importance of structure. Having set times for meetings, classes, and other appointments used to help keep us on track. We couldn’t avoid or put off doing things when we were expected to show up or face immediate consequences. Now, a lot of us find we easily give in to doing all those things we also need to do and prefer over the more mentally taxing activities (hello procrasticleaning!). With a large amount of ambiguous flexible time, we’re vulnerable to doing all these things that allow us to feel productive but that are also easier to initiate than the work we should be doing.

The other thing I’ve noticed, especially amongst college students, is considering the day to have 24 “useable” hours. With all this time available for getting work done, watching 2-seasons of the latest Netflix original, videogaming, or just sleeping in until noon doesn’t seem like a big deal. You’ve got all night to get on task right? Maybe not.

The problems I’ve observed in holding to the 24-usable hours perspective include the development of significant sleep difficulties. I have a lot to say about sleep hygiene, but I should probably leave that for another post.

 Another problem is failing to consider when you’re at your “peak” in terms of alertness and ability to tackle complex tasks. Research suggests that most of us are more capable of processing high-level information and produce better quality work in the morning. While this isn’t everyone, it’s important to know when your peak hours are so to avoid wasting them on tasks that don’t require as much brain power.

Finally, considering the whole day to be available for work or academic endeavors makes it increasingly easier to continue to put things off. “It’s OK if I don’t get to it today, I have ALL day tomorrow…” and repeat 7 days a week.

So what can we do to help ourselves during “these unprecedented times” that keep going, and going, and going?

First, get that structure back. This isn’t fun at first, but even if you don’t have an early meeting, and even if you don’t have to spend time doing your hair and makeup any more, get yourself up and going at the same time (or about the same time) every day. Establish a designated work space, and develop a routine. The more you do it, the less you’ll have to think about it, and the less likely you’ll be to deviate from it.

Second, and I know this sounds counterintuitive, but limit your work time. Set “business hours” and stick to them. Take into consideration what time you feel like you’re capable of being most productive as well as what other obligations you have. After establishing what time you’re going to wake up and get started, decide what time to call it quits and devote the rest of the day to yourself, your family, your home, etc. Remember when you were in the office and you were both eager to get out of there by 4:30, but also didn’t want to (or couldn’t) leave things dangling until tomorrow? Try to adopt this same mentality, and you may be pleasantly surprised by how much you are able to accomplish- all while maintaining time for the things you really want to do.

Lastly, don’t forget to schedule breaks. How you do this depends on your personal preferences and style, so feel free to test out a couple different strategies. Maybe you decide on a time to take a break no matter what you may be in the middle of doing. Just set a timer for that time, and when it goes off, don’t hesitate to  drop everything, and kick back or grab a snack.

Alternatively, look over your to do list for the day and decide after completion of which task or tasks you will reward yourself with a break. To make optimize your breaks, decide on a length of time that will allow you to recharge to some extent but that is not so long that reinitiating work is a challenge. Setting a timer may be helpful for 10-30 minutes may be helpful for this. On the other hand, you may find it more helpful to decide on a break activity and return to work after it is completed (e.g., have lunch, take a walk around the block, sort some laundry, etc.).

it’s uncertain how long “these times” will last, but I think these are effective strategies you can take with you to allow you to be more adaptable and resilient as you face the next thing that can disrupt your ability to be productive.

My Mission

Something’s missing, and I want to fill the gap

I want to take Rehabilitation Psychology out of the hospitals and bring it into the community, whereby psychology services can be truly ACCESSIBLE to the people who could benefit from them.


I believe Psychology as a health discipline has made tremendous advances and continues to work toward ensuring that community-based care is INCLUSIVE of all individuals regardless of their racial, ethnic, cultural, and religious backgrounds, as well as their gender and sexual orientation- meaning no matter your background, you should be able to confidently walk into a local psychologist’s office and find someone skilled in addressing your emotional/cognitive/behavioral needs.


In contrast, I have not found the same to be true for individuals with chronic health concerns or disability as part of their identity or the identity of their loved one(s). What I’ve found, is that providers with the appropriate training to treat members these communities are almost exclusively housed within hospitals or formal outpatient rehabilitation programs where the primary focus is recovery from the disability or health condition.


While these programs are excellent and essential for addressing acute needs and assisting individuals in their initial adjustment from “healthy person” or “able-bodied person” to “person with a disability” or “person with a chronic illness, I wonder, What happens when those people phase out of that program?


Despite what the media and standard medical education would lead us to believe, there are people who are living in this world (even in our own community) with disabilities and/or chronic health conditions that make their work and leisure activities look different from the norm. Some of these people are living independently, while others are directing assistance provided by professional or family caregivers. These people are working, playing, shopping, and traveling within the able-bodied world and are vulnerable to depression, anxiety, work-stress, relationship issues, and substance abuse just like everyone else.


My fear is that when these people walk, hop, or roll into an outpatient psychology clinic, the average clinical psychologist, therapist, or counselor is going to feel intimidated by their health or disability status, have difficulty looking past it, and be quick to associate their distress only to this status (i.e., “Obviously you’re depressed because you use a wheelchair/have burns, engage in self-catheterization, are post-lung transplant, etc.”). I am afraid that these providers may not be able to appreciate how this status impacts someone’s life without being the only focus of his or her life.

I’ve noticed that these individuals often find themselves in a “limbo” of sorts. They’re not “sick enough” to access the psychologist who treated them in acute care or an outpatient physical rehabilitation program. They also shouldn’t be expected to rely solely on providers housed within specialized programs for individuals with a particular condition (e.g., MS, TBI, stroke, amputation, organ transplant, etc.) Moreover, these programs often have extraordinary hoops to jump though to access services in order for them to manage the demand of patients who have acute needs.


My mission is to use my training and experience to provide well-rounded psychology services to individuals with varying abilities and health needs in the context of everyday life.


For example, let’s say you were diagnosed with transverse myelitis (inflammation of the spinal cord) ten years ago. You completed the prescribed inpatient and outpatient rehabilitation programs, spent a few years living with your family, and have been living independently for the last six years. You work a full-time job and enjoy doing things typical of others your age. You use a wheelchair for mobility, have some peripheral nerve pain, and rely on timed voids and a bowel program to maintain your continence. You have recently noticed that you aren’t enjoying life as much as you used to, you’re feeling burned out at work, and you feel like something is missing in your life. You decide to see if psychotherapy is helpful. You called the rehabilitation clinic where you were seen after your acute hospitalization, but the psychologist there is only taking patients who are currently involved in the comprehensive rehabilitation program. You know there is a psychology clinic in town next to the place you get your hair done, but the thought of explaining your lifestyle to a new person sounds like more work than it’s worth. Ugh. What can you do?


Or consider that you’re the husband of a woman living with a terminal brain tumor that has taken away her ability to understand and produce intelligible language. You’re having difficulty coping with the lifestyle changes this has brought on, not to mention the anticipatory grief. You’ve never seen any type of mental health provider before, but your family is encouraging you to get some support as well as some strategies for coping with your wife’s evolving needs. There is no way you’re going to set foot inside a hospital- you’re not “sick” or “crazy,” but you want a provider who understands the neuropsychological underpinnings of your wife’s condition, and that this isn’t just a “marriage issue.” Where can you go?


After training and working as a licensed psychologist in large medical settings for the last ten years, I’ve had the opportunity to learn from and about many different rehabilitation populations and the disability community. At this point in my life and career, I’m excited about breaking out of the medical centers and some of the restrictions they impose. I am eager to bring Rehabilitation Psychology services to individuals who are out in the world, living their lives, and deserve access to someone who understands and appreciates their lifestyle, challenges, successes, and goals. I’m hoping I can be your “neighborhood rehabilitation psychologist.”

Rehabilitation Psychology 101

The basics

he American Board of Professional Psychology defines Rehabilitation Psychology as a specialty area within professional psychology which assists the individual with an injury or illness which may be chronic, traumatic and/or congenital in achieving optimal physical, psychological and interpersonal functioning. The focus of rehabilitation psychology is on the provision of services consistent with the level of impairment, disability and handicap relative to the personal preferences, needs and resources of the individual with a disability. The rehabilitation psychologist consistently involves interdisciplinary teamwork as a condition of practice and services within a network of biological, psychological, social, environmental and political considerations in order to achieve optimal rehabilitation goals.

So what does that mean?

Basically, a Rehabilitation Psychologist works with people with significant injuries, physical and sensory impairments, and/or chronic illnesses which may alter their everyday physical, cognitive, and/or emotional functioning.  Typically through psychotherapeutic assessment and interventions, the Psychologist helps the individual develop strategies for minimizing barriers to reaching their goals- whether they’re caused by their disability/health condition or not. 

Rehabilitation Psychologists may also work with family members of people with injuries, chronic health conditions, and disabilities even if they do not personally experience challenges associated with these conditions. Having the dual role of parent, spouse, sibling, friend, neighbor, or extended family member AND caregiver can be extremely difficult. Those that provide support to people with disabilities are often also essential in helping them enhance their quality of life.

How are you different from a typical clinical psychologist or counselor?

Many Rehabilitation Psychologists, like myself, have trained and worked in healthcare settings that serve people at various stages of treatment or recovery from a wide range of health conditions. My familiarity with the trauma associated with being in an intensive care unit and prolonged hospitalizations and my appreciation for the daily challenges of someone who is living with multiple sclerosis or a spinal cord injury, for example, allows me to more effectively address the needs of individuals who have been though these experiences and who continue to live with these conditions as well as those who play important roles in their lives. 

Additionally, my experience working with interdisciplinary treatment teams in hospital and outpatient settings allows me to more easily understand ongoing healthcare needs and establish appropriate contacts with other treatment providers as needed to enhance my patients’ quality of life.