Feminist Therapy: Balancing self-care, safe space, and moving forward after trauma

feminist therapy

I am a therapist, but I am not your therapist. Therapy, in my opinion, is not just about the information I give, but also about the highly individualized relationship I build with each client, getting to know their unique needs, strengths, and challenges. This column is not meant to substitute individual therapy. When in doubt, speak to a therapist about these issues — preferably someone who knows you, who you feel safe with, and who is equipped to support you exactly as you are.

** All of the questions I received were complex, and profoundly honest. Thank you for your submissions. The questions answered in this month’s column were edited for length and privacy, while attempting to preserve the original question.

Dear Feminist Therapist,

Since I was raped, I’ve found it really hard to be around lots of people. I’ve been staying home more, prefer to be on my own, and find it difficult to interact with people in the way I used to — being at home or on my own has also felt a lot safer. This has been really frustrating for a few reasons. First, I wasn’t raped in a public place so it feels like my anxiety doesn’t make any sense. Second, people in my social circles haven’t been able to understand this, and don’t understand why I’m not coming out as much as I used to. I know they’re trying to be supportive, but it has made me feel pressured — like they just don’t understand me. I can’t figure out what to do about all this. Am I letting the anxiety control my life? Are my friends right? Am I actually taking care of myself?

– A

Dear A,

I’m so glad you wrote in — I am really impressed by your question, and think a lot of people wonder about whether their coping behaviors are perpetuating their problems or helping to resolve them. It is very normal for there to be anxiety after having been through a trauma. Up until the most recent version of the DSM came out, PTSD was classified as an anxiety disorder because of the way that it presents itself. It is important to understand that part of having trauma (and PTSD in particular) is that avoidance or withdrawal is a key symptom. On the other hand, when we’ve been hurt, it is very important that we be able to protect ourselves and take time to heal. Two key components of what defines trauma is that it makes us feel overwhelmed and powerless — taking care of yourself or getting out of overwhelming social situations can make us feel less overwhelmed and more in control, effectively giving us a temporary emotional antidote to the trauma.

Removing ourselves from situations that cause us anxiety can be a function of the anxiety (withdrawal and avoidance) that actually fuels it by making certain parts of our brain/body believe we cannot handle the stressful situation and that the only way to feel better is to avoid it. But removing ourselves from overwhelming situations that prevent us from healing can also be exactly what we need. It’s a delicate balance, and one that I recommend talking to a therapist about so that you don’t have the make choices alone and can discern the confusing difference between avoidance and self care.

The other piece that you’re mentioning is that people don’t often understand how trauma works, how it affects us, and what we might need to heal. If you have people that you feel close to and comfortable with, you could try connecting and spending some time together — if it feels safe, tell them you’re struggling, and that things that used to be easy feel difficult and painful now. People generally respond well when provided with suggestions about practical ways they can help. Maybe it would help them to know that you still want to be invited out to events, but you don’t want to feel pressured to attend. Or, you could tell them that right now, hanging out one-on-one is a better way to spend time together.

The sociocultural pieces here are obvious: we exist in a culture that breeds trauma (particularly sexual trauma for girls and women) but currently we don’t have an adequate sociocultural narrative that provides support for the people who are most hurt. Women, often on the receiving end of relational or sexual trauma, commonly find their ways of coping are silenced, pathologized, or dismissed. Even in their efforts to heal or get their psychosocial needs met, women are often hurt again by a society that perpetuates trauma and abuse and doesn’t know how to help people heal.

Thank you for asking your question. I have hope that just in asking this question, someone might learn how to better support people in their lives who have stories like yours.

~~~

Dear Feminist Therapist,

I have never been to see a therapist (I’m not sure if I’m ready for that yet), but I read lots of books about mental health. The term “self-care” comes up a lot, and I’m not sure why, but I feel uncomfortable with it. At the same time, I’m intrigued. Basically, I have a reaction to something I know nothing about. A lot of people seem to have this kind of reaction, and I tend to think that uncomfortable feeling is there for a reason. I’d like to hear your take on what “self-care” is and why I might feel uncomfortable with the term. Thanks.

– D

Dear D,

Whether or not you are aware, your questions are politically loaded. I’m delighted by your awareness of your own discomfort and your willingness to examine what that it might reveal.

First, “self-care,” as a construct, denotes the behaviors, thoughts, and feelings associated with caring for ourselves. That can mean all sorts of things —  caring for one person might look different than how another person cares for herself. We all need different kinds of care, but we all need care.

I believe that, in patriarchal societies, women are socialized to disappear. For a long time — and even still — the idea that we as women can “take up space” has been particularly unpopular. Women, historically, have provided most of the relational care for members of their families and communities — often this has come at a cost to themselves. It’s not surprising, then, that women struggle with self-care for a variety of reasons. For some of us, taking good care of others and not asking for anything in return, even from ourselves, has been like a badge of honor: we take pride in not needing care. For others, our difficulty accepting care (from others or ourselves) reflects a deeply held belief (shaped by our interpersonal relationships and sociocultural context) that we are not worth caring for. Whatever the reason, difficulty or discomfort around self-care tells us something about who we are as a “self” and what we believe we need, don’t need, deserve, or don’t deserve.

It’s worth noting that the construct of “self” varies from culture to culture, so what we believe about self-ness in Western cultures is typically more individuated than other cultures that see the self as a reflection of community relationships (“who I am is who we are.”) These cultures see caring for others as a way of knowing who/what the self is. So your reaction could be a rejection of our narrow definition of self, and the fragmented nature of our very individual and disconnected lives.

As a therapist, it’s been helpful for me to understand self-care in my work. All day, I care for others and notice that when I have not taken time to care for myself, I get depleted, frustrated, impatient, and hopeless in my work. A useful metaphor (although imperfect) is of oxygen masks on airplanes: flight attendants always remind us to put our mask on first, before we help another person with their mask. The more intense the work I do, the more I need to make sure my “oxygen mask” is on before I help others put theirs on.

Self-care is different for everyone, but does not have to be extravagant, expensive, time-consuming, or creative. It can be as simple as doing something you normally do (like having a bath) but with the added intention of being caring and kind to yourself. Sometimes the best self-care is when we take time to slow down and breathe for a few moments before and after a difficult meeting, stretch before bed, go for a walk when feeling stressed, or schedule a fun activity after a demanding week. Try doing an activity of your choosing with the intention of being caring for yourself, and see how it feels. Perhaps the feeling you will have will clarify the source of your discomfort, or eradicate it all together.

~~~

Dear Feminist Therapist,

I’ve recently been diagnosed with borderline personality disorder and I have a history of depression. I feel good knowing that what I’m going through has a name, but also really conflicted about how the system of diagnosis pathologizes the female experience. I’m angry that something as big as my experience of being alive can be narrowed down to a few words — a box, if you will. But I’m also so glad that I’m not the first person to feel life is always so hard. I’m struggling with the idea of having a diagnosis, and would love your thoughts on that.

– G

Dear G,

I hear so much of myself in your story. These are complex things you are wrestling with: some existential, some political, some just very human. I believe that we all want to be understood and feel like our experience of pain makes sense to someone. Our systems of diagnosis, and how people often respond to those specific disorders, can be incredibly dehumanizing and objectifying. As discussed in the question above, our culture often pathologizes people’s normative reactions to experiences that the culture is responsible for shaping. This can leave people feeling like they are the “sick” ones, when actually they are responding appropriately to the traumas, stressors, isolation, and sadness of living in this culture. (I often wish there were ways to diagnose cultures!)

Although you may already know this, our understanding of what a mental illness is and the criteria that shape a diagnosis are all constructs shaped by sociopolitical forces. For this reason, I don’t always find it helpful to use diagnoses (or provide them for clients) unless it actually benefits them in some way (getting funding, support, normalizing their experience, etc.). Rather, I choose to see the person first, the story of her life, and how she has responded to, and coped with, suffering and distress. Sometimes it can be useful to look at how one’s coping and response is causing her more suffering and draw on empirical evidence to understand what are the most ethical and effective ways to help her make the changes she wants to make in her life. And, like I said, if having a diagnosis (a fancy way to group clusters of symptoms/specific responses/coping behaviors) actually helps a person, then it may be appropriate to do so. But only in a way that helps to humanize and heal the person, not limit, objectify, label, or shame them.

I must confess that I find it difficult to work within a system and use language that I believe is often harmful. It presents ongoing moral and ethical dilemmas, requiring constant assessment in order to figure out whether what is being done is actually helpful. While you may have been given these “labels,” you can choose to reject them as definitive descriptions of the complexity of who you are. Instead, you have the option to use them only when it is helpful and healing for you, like when exploring treatment options with care providers or informing loved ones about what you may need from them.

I like the idea of person-first language as it reminds us that we are people, not just clusters of symptoms. For example, instead of saying “the schizophrenic over there,” we might say “That’s Joan”, and then later, if appropriate, “Joan has been diagnosed as having Schizophrenia.” It may be helpful for you to apply the example of “person-first language” to yourself, reminding yourself that you are a whole person and that the diagnosis, although political, is just a way for a very small sliver of people to better understand how to help you. That said, we need to continue to challenge normative reactions to sociopolitically charged stressors, while also making it safe for people to talk about their stories and pain in ways that help us understand them. We must, as a feminist community, continue to look at how women’s experiences of oppression are marginalized or dismissed, and contribute to a cycle of silence and further oppression.

You can send your questions for Hillary, our Feminist Therapist, to info@feministcurrent.com or hillarylmcbride@gmail.com with the subject: “Feminist Therapy,” or tweet her @hillarylmcbride using the hashtag, #feministtherapy. (We will anonymize your questions, unless you specifically ask us to include your name.)

Hillary McBride
Hillary McBride

Hillary McBride is a registered clinical counsellor working in the Vancouver area. She specializes in women’s experiences and feminist therapy. Hillary is a PhD student at the University of British Columbia, where she researches women’s experiences using feminist methodologies. She is the author of “Mothers, Daughters, and Body Image: Learning to Love Ourselves as We Are” and recently won the International Young Investigator Award in Human Sexuality from Taylor & Francis for her research and clinical work on sexuality in mothers.

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  • Karla Gjini

    I love this column so much!
    Thank you!

    regarding self care.. I love what you said about how we’re expected to take care of everyone first and then see what’s left over for ourselves.. this is so frustrating to me most women I know feel guilty for doing anything for themselves and it’s a big problem I think

    there are so many ways to take care of yourself or do self care without spending money or even a lot of time but like you said, a lot of those things we’re socialized to not ask for because we’re busy taking care of or accommodating others

    more than massages and meditation.. I have found the biggest tool of self care I have been cultivating is saying NO. no I don’t want to go to your stagette no I don’t want to go out for coffee with you no you cannot pick my brain no I won’t be able to come for dinner no I’m not interested in…. etc

    anyway this topic is super important and interesting to me, so thank you for the question and thank you for the answer!!!

  • squizzlenut

    I’m especially interested in the question about self-care, because I’m also very uncomfortable with the concept. Having thought about it, I don’t think it’s the basic idea of looking after yourself by taking time to relax, saying no to things you don’t want to do etc., that seems very sensible and healthy, it’s something to do with the framing of it as ‘self-care’.

    The best way I can describe it is that it strikes me as asking you to do something for yourself that should really be done by other people. Calling it ‘self-care’ seems to conflate healthy relaxation which can be done alone, with the need for affection and care from other people which obviously can’t be done alone. It puts me in mind of hand-reared baby monkeys that rock against a soft toy because it feels a bit like being carried on their mother’s back. It’s better than nothing, but it’s a poor substitute for what they really need and they only even want to do it because they are not receiving care from other monkeys. To me, ‘care’ seems like something that fundamentally must be done by other people, and I’m not comfortable using the term to describe healthy downtime.

    For women specifically, I worry that the tendency you mention for us to always put ourselves last could make ‘self-care’ into a concept that encourages us to try to take care of all our needs alone when we shouldn’t have to. The idea of ‘caring’ for yourself (as opposed to respecting yourself and your own needs) seems unhealthily individualistic to me, as well as reminding me of the push to react to everything with a personal attitude adjustment rather than considering that external circumstances may be to blame which was mentioned in the other replies. It seems like it could really easily become yet another way to avoid making any demands on others.

    Anyway, I’m doing a horrible job of explaining myself but that’s roughly why the whole ‘self-care’ thing bothers me, I wondered if the letter-writer might be feeling a similar sort of discomfort?

    • gluon

      You haven’t done a bad job of explaining yourself. I had a similar uncomfortableness in reading the response to the issue of “self-care” and I agree 100% with what you said.

    • Karla Gjini

      thanks for writing this.

      I think I understand what you mean and it’s true..avoiding making demands or even expectations of others is really difficult and I think that’s a massive part of the “putting others first” component of being socialized as a women. Do you think that respecting yourself and your own needs is something completely different to caring for yourself?

      • gluon

        I’m not the OP, but part of the problem with “self-care” is that it is not (nor should it be) something women can rely solely on themselves for. There is an aspect of being a human and getting your needs met that requires the participation and consideration of other people. Women do a whole lot of caring for others, but who takes care of them? Who is considering what they need? The idea of “self-care” suggests a woman take care of 100% of her needs, which is impossible. Yes, women should prioritize themselves more in their own lives, but the rest of the people in each individual woman’s life need to put her first sometimes too (ie. reciprocation). The point is not for women to stop performing emotional labor (though we should certainly reduce how much of it we do), but for other people/men to step up and assume some of the responsibility.

        A parallel might be housework: women moved into the workplace and claimed some of that space for themselves, but men did not step up and do their share of housework. So women have the “second shift.” It is similar with caring for others and “self-care” – women are now being encouraged to cut back on how much they do for others and to take time for themselves (good things), but men are not stepping up to share the emotional work. Women have the double burden of meeting everyone else’s emotional needs and also meeting their own (second “emotional labor” shift?).

        Anyway… I’m not intending to speak for squizzlenut at all, she may not agree with my take here, but that’s what I see of it.

        • Karla Gjini

          Thank you for the thoughtful response. I like how you explained it with the second shift idea… although it’s more like the fourth or fifth unfortunately haha

          I wonder if because it’s easier to prioritise ourselves and only focus on that instead of also questioning why others aren’t putting us first ever is why the whole self care idea sometimes feels hollow, even when you’re doing all the right self care steps.

          I haven’t thought of that reciprocal component but it makes complete and utter sense.. thnk you both @disqus_2lMFLIO8pz:disqus @squizzlenut:disqus

      • squizzlenut

        I suppose I think that there’s a difference between caring ABOUT something/someone, in the sense of ‘thinking it is important and worthy of consideration’, and caring FOR something/someone, in the sense of ‘providing for its safety, health and wellbeing’. The difference is subtle but I think it’s important? Generally you put in the effort to care for something because you care about it so the terms are used interchangeably in normal speech, but the two aren’t inseparable. (e.g. I may care ABOUT my cousin but not care FOR her because her immediate family does that, and I may not care ABOUT an unpleasant family member in more than an abstract way but still care FOR them in their old age because I consider it morally correct to do so.) Does that make sense?

        I think it’s totally reasonable to encourage women to care ABOUT ourselves more, because we’re raised to devalue ourselves. My problem with ‘self-care’ is it often implies we can care FOR ourselves, which is only true in a very limited way. As gluon said already, ‘there is an aspect of being human and getting your needs met that requires the participation and consideration of other people’.

        So to answer your question I guess I think respecting yourself and your own needs is related to but still distinct from caring for yourself?

    • HillaryLMcBride

      @disqus_2lMFLIO8pz:disqus @karlagjini:disqus @squizzlenut:disqus

      Thank you so much for your comments- you’ve added so much richness to this dialogue. These are complicated issues, and political. As a relatively new ‘construct’ in the mental health sphere, these are constructs which need to be refined, shaped, critiqued, and celebrated- as we see fit. My understand of the self, is one of several internal relationships, and so I think of our self-care as being like a kind of relational caring, where we are allowing parts of us to nurture other parts of ourselves. If you’re curious about this, I can suggest some more resources which explain this in depth. The idea of a multi-dimensional self is seen clearly in the work of several feminist psychologists, including Carol Gilligan, who has created feminist methods of qualitative research which address the complex relational development of the self, and how our ‘self’ as women is best understood through the lens of music – like an orchestra, the final sound, is made up of many sounds. Gilligan’s methods of feminist inquiry look at the self of women as expressed in contrapuntal voices (many internal narratives, ones of victory, one’s carrying pain, ones which know how to nurture, one which need nurturing, etc) that all together form our our ‘self’.
      I wanted to make was that self-care IS NOT, and will never ever be a replacement for others caring for us. Self care, on the other hand, is about us saying that in addition to the others around us who care for us, we can also having a loving, kind, and restorative relationship with ourselves. They are not substitutes for each other. The idea of a person who does not need care from others sounds unhealthy to me, but actually sounds just as unhealthy to me as someone who is unable or unwilling to care for themselves. I believe we need both. But, perhaps there is a better term to use if the term ‘self care’ doesn’t fit.

      • gluon

        Thank you for sharing this information, and thank you for clarifying on the role “self-care” plays, ie. it addresses part of the equation for women’s personal emotional needs but is not itself the whole solution. I can agree that the suggestions presented in your article for “self-care” (taking a walk, deep breathing, stretching, etc. with the added intention of being kind and caring to ourselves) are most certainly useful/helpful when viewed as playing a part, but not in and of themselves meant to solve the problem of women’s unreciprocated emotional work.

        I also wouldn’t mind reading more on this concept of the “self” as you’ve described, if you don’t mind suggesting those resources!

        • HillaryLMcBride

          I appreciate your perspective and additions- would you consider writing in a question? Some good stuff to read about ‘self’ on this topic, particularly from a feminist perspective:
          in a different voice- gilligan
          mapping the moral domain – gilligan et al.
          women’s ways of knowing
          women’s growth and diversity
          towards a new psychology women
          women’s growth in connection
          the birth of pleasure – gilligan
          meeting at the crossroad- gilligan and brown

          • gluon

            Thank you for the list!

      • squizzlenut

        Thanks so much for your reply! I’ve come across this way of understanding the self before and I do think it’s useful. I don’t worry so much about the use of ‘self-care’ as a concept in professional therapy, since in therapy you’re actually talking to the person individually and if you see they’re starting to interpret the concept in a harmful way you can address that directly. It worries me more because it’s drifted into mainstream use where the context you’ve provided is rarely attached, and it may be read by hundreds of people who have nobody checking if it was helpful or harmful to them, if that makes sense?

        To use another analogy, you know how the term ‘male gaze’ is often misused because it sounds easier to understand than it actually is? People read it and think it just means ‘when men look’ when it’s really a term for the cumulative effect of male dominance on our whole way of interpreting visual culture and is really quite a complicated and nuanced concept. It gets misinterpreted by laypeople because it sounds self-explanatory when it isn’t.

        I worry ‘self-care’ is a term vulnerable to the same problem. Even in your reply here, it would be easy to get the impression on a cursory read that ‘self-care’ and ‘care from others’ are just two ways of getting the SAME thing, because they’re described with the same word, when they’re actually serving two different sets of needs. Uses I’ve seen floating around in the mainstream often (accidentally, I hope) suggest that one can meet one’s own emotional and social needs all alone because this distinction is not clear enough.

        It seems like a such a petty quibble, but I think a change in the terminology to make the distinction clearer would genuinely make me much more comfortable with the concept!

        • Karla Gjini

          it’s not a petty quibble it’s completely valid! I’ve just started reading this book about self compassion by Kristen Neff and that term might be a bit closer… but I agree language is important and if in our heads we’re not distinguishing between caring for and caring about because it’s the same word, the onus stays on the women to do everything for everyone, including ourselves.