Tag: mental-health

Therapy

The Power of Positive Self-Talk

S. Reimers, JD/LICSW

What It Is, What It Isn’t, and Why It Matters

Negative self-talk is so common that many of us barely notice it. It’s the quiet background noise of the mind: You should be further along by now. Why can’t you do this like everyone else? You always mess things up. For some people it’s an occasional visitor; for others it’s a near-constant narrator. Either way, the way we talk to ourselves shapes our emotions, our behavior, and even our sense of what’s possible in our lives.

Let’s look at the real costs of negative self-talk—and why learning a more compassionate, constructive inner voice isn’t just “feel-good fluff,” but a practical life skill.

The Hidden Costs of Negative Self-Talk

1. Living by Imaginary Standards

A lot of negative self-talk comes from comparing ourselves to standards that are unclear, unrealistic, or not even ours. We absorb ideas about success, productivity, beauty, or likability from family, culture, or social media, and then silently punish ourselves for not measuring up.

The cost? Chronic dissatisfaction. When the bar is always moving—or impossibly high—you never get to feel “enough.” Even real accomplishments feel hollow because the inner critic quickly shifts the goalposts.

2. Shame About Traits and Performance

Negative self-talk often targets stable traits (“I’m lazy,” “I’m awkward,” “I’m bad with people”) instead of specific behaviors. This turns temporary struggles into identity-level judgments.

Shame is particularly costly because it makes change harder. If you believe a flaw is who you are rather than something you do, why try? Shame also pushes people toward hiding, withdrawing, or perfectionism—none of which support growth.

3. Emotional and Physical Toll

Research consistently links harsh self-criticism with higher anxiety, depression, and stress. Your brain doesn’t fully distinguish between an external bully and an internal one. Repeated self-attacks can keep your nervous system in a mild threat state, raising stress hormones and draining emotional energy.

4. Reduced Motivation

Many people believe self-criticism keeps them accountable. In reality, it often does the opposite. When tasks are paired with self-attack, your brain learns to associate effort with pain. Procrastination and avoidance then make perfect sense—they’re protective moves.

The Benefits of Positive Self-Talk

Positive self-talk isn’t about pretending everything is great. It’s about speaking to yourself in ways that are accurate, kind, and useful.

1. Greater Resilience

When your inner voice says, That was hard, but you handled parts of it well and you can try again, setbacks become information rather than verdicts. You bounce back faster because your self-worth isn’t on the line every time.

2. Better Performance

Athletes and performers use constructive self-talk to improve focus and persistence. Statements like Stay with it, One step at a time, or You’ve done hard things before help regulate emotions and maintain effort.

3. Healthier Relationships

The way you talk to yourself often spills into how you relate to others. When you’re less harsh internally, you tend to be less defensive, less approval-seeking, and more open. Self-compassion makes room for compassion toward others.

4. A Stable Sense of Worth

Genuine positive self-talk builds worth that isn’t dependent on constant success. You become someone who can say, I value myself even while I’m growing.

Practical Strategies for Shifting Self-Talk

1. Notice and Name It

You can’t change what you don’t notice. Start by catching your inner commentary. Some people find it helpful to write down recurring phrases. Label them gently: That’s my inner critic talking.

2. Use the “Friend Test”

Ask: Would I say this to a good friend in the same situation? If not, try rephrasing.

  • From: I’m terrible at this.
  • To: I’m still learning this.

3. Aim for Believable, Not Rosy

Your brain rejects statements it knows are false. Instead of I’m amazing at everything, try I’m improving, or I can handle this step. Realistic encouragement works better than over-the-top praise.

4. Try Self-Compassion Breaks

A simple tool from self-compassion research includes three steps:

  • Mindfulness: “This is a moment of struggle.”
  • Common humanity: “Struggle is part of being human.”
  • Kindness: “May I be kind to myself here.”

This interrupts the spiral of self-attack.

5. Externalize the Critic

Some people imagine their inner critic as a character or voice separate from their core self. This can make it easier to say, Thanks for your input, but I’m choosing a different response.

6. Values-Based Self-Talk

Instead of focusing on how you feel or how you compare, focus on what matters to you.

  • I’m choosing to do this because I value growth.
  • I care about being reliable, so I’ll take one step.

This anchors your self-talk in direction, not judgment.

Tools That Can Help

  • Journaling: Track patterns in your thinking.
  • Cognitive Behavioral Therapy (CBT) worksheets: Help challenge distorted thoughts.
  • Mindfulness or meditation apps: Build awareness of inner dialogue.
  • Voice notes to yourself: Some people benefit from literally recording encouraging reminders.

You don’t need all of these—just one or two practiced consistently.

Genuine vs. Toxic Positive Self-Talk

It’s important to distinguish healthy positive self-talk from what might be called “toxic positivity” or narcissistic self-talk.

Genuine positive self-talk is:

  • Grounded in reality
  • Open to feedback
  • Compassionate toward self and others
  • Aimed at growth

Examples:
I have strengths and weaknesses like everyone.
I made a mistake and I can repair it.

Toxic or narcissistic self-talk is:

  • Inflated and defensive
  • Dismissive of others
  • Resistant to accountability
  • Used to prop up fragile self-esteem

Examples:
I’m better than everyone else.
Nothing is ever my fault.

The key difference is that genuine positive self-talk includes humility and responsibility. It doesn’t deny flaws; it holds them in a larger, kinder perspective.

Your inner voice is one of the few companions you have for life. It can be a harsh drill sergeant or a steady coach. Changing it doesn’t happen overnight, but small shifts matter. Each time you replace a cruel thought with a fair and supportive one, you’re not just “being nice to yourself”—you’re building a mental environment where growth is actually possible.

Therapy, Uncategorized

Fear-Based Avoidance

S. Reimers, JD/LICSW

Fear-Based AvoidanceWhen Protection Turns Into a Prison

Fear gets a bad rap, but it didn’t evolve to ruin your life. Fear exists because bodies are ancient survival machines. Long before there were performance reviews, family group chats, or dating apps, fear kept our ancestors from walking off cliffs or petting animals with too many teeth. At its core, fear is a protective biological process: your nervous system scanning for danger and mobilizing you to survive it.

The problem isn’t fear itself. The problem is when the fear dial gets turned way too high.

Modern fear is often wildly mismatched to modern threats. Our bodies respond to social rejection, uncertainty, and emotional discomfort as if they were physical dangers. The same system that once helped us escape predators now floods us with adrenaline because we might say the wrong thing, feel embarrassed, disappoint someone, or fail at something that matters. Fear starts overestimating danger while underestimating our ability to cope. And when that happens, avoidance can quietly take over our lives.

Fear-based avoidance sounds reasonable on the surface. I’ll do it when I feel more confident. I’ll speak up once I’m less anxious. I’ll pursue that thing after I fix myself first. But avoidance doesn’t make fear shrink. It teaches your nervous system that fear was right all along. Every time you avoid, your brain learns: Good call. That was dangerous. The fear grows stronger, broader, and more convincing.

This is where Acceptance and Commitment Therapy (ACT) offers a different approach—not about eliminating fear, but about changing your relationship to it.

Fear Is Sensation Plus Story

ACT draws an important distinction between the physical sensations of fear and the stories our minds tell about those sensations. The body does its thing: racing heart, tight chest, shallow breathing. The mind piles on meaning: This is unbearable. This will end badly. You can’t handle this.

Those thoughts feel authoritative, but they’re not commands—they’re mental events. ACT calls the process of stepping back from them cognitive defusion. Instead of arguing with fear (“This isn’t scary!”), you notice it: I’m having the thought that this will end in disaster. That small shift creates space. You’re no longer inside the story; you’re observing it.

Fear loses some of its grip when it’s seen as information rather than instruction.

Values Give Fear a Direction

Avoidance thrives when fear is the boss. Values flip the hierarchy.

Values aren’t goals you complete; they’re directions you move in. Connection. Integrity. Creativity. Justice. Curiosity. Care. They answer the question: What kind of person do I want to be, even when it’s uncomfortable?

ACT doesn’t ask, How do I get rid of fear so I can live my life? It asks, What do I want my life to stand for—and am I willing to feel fear in service of that?

This matters because fear shows up most intensely around things that matter. If you didn’t care, you wouldn’t be scared. Anxiety before speaking up often points to a value of honesty or fairness. Fear of rejection often signals a longing for connection. Fear isn’t proof you’re weak—it’s evidence that you’re alive and invested.

Accepting Pain Without Surrendering Your Life

Acceptance in ACT doesn’t mean liking fear or resigning yourself to suffering. It means making room for discomfort without letting it decide your behavior. You stop fighting sensations that can’t be controlled and start focusing on actions that can be chosen.

Try this in real time:

  • Name the sensations (“tight throat,” “heat in my face”).
  • Breathe into them rather than away from them.
  • Remind yourself: This is uncomfortable, not dangerous.

Pain shrinks when it’s allowed and grows when it’s resisted. Avoidance trades short-term relief for long-term restriction. Acceptance trades short-term discomfort for long-term freedom.

Courage Is Usually Small and Repetitive

We tend to think of courage as something dramatic: charging into battle, stepping onto a stage, making a grand declaration. But most courage is quiet and unglamorous. It’s sending the email you’re tempted to overthink for a week. It’s staying present during a difficult conversation. It’s showing up imperfectly instead of waiting to feel ready.

Courage isn’t the absence of fear. It’s choosing to act while fear rides along in the passenger seat.

ACT emphasizes commitment—making small, values-based promises to yourself and keeping them, even when your mind protests. Start tiny. Not “I’ll never avoid again,” but “I’ll take one step toward what matters today.” Momentum builds through repetition, not intensity.

Practical Ways to Challenge Fear-Based Avoidance

  • Name the function of avoidance. Ask, What is this avoiding helping me not feel right now? Relief, embarrassment, vulnerability?
  • Shrink the step. Fear thrives on vagueness. Make actions concrete and doable.
  • Bring fear with you. Stop waiting for it to leave. Say, You can come, but you don’t get to drive.
  • Track values, not comfort. Measure success by alignment, not ease.
  • Practice defusion daily. Thoughts repeat; your relationship to them can change.

Fear will always try to keep you safe. Thank it for the intention—and then gently remind it that safety is not the same thing as living.

You don’t need to be fearless to live boldly. You just need to be willing.

Therapy

Burnout…

S. Reimers, JD/LICSW

What It Is and How to Recover

Burnout Defined

Burnout is a word we hear often, but many people don’t recognize it until they’re already deep in it. It’s not just feeling tired after a long week or unmotivated for a day or two. Burnout is a state of emotional, mental, and often physical exhaustion caused by prolonged stress—especially when that stress feels relentless, unavoidable, or disconnected from meaning or reward. It can creep in quietly, disguising itself as “just pushing through,” until even simple tasks feel overwhelming.

At its core, burnout happens when demand consistently exceeds capacity. You give more than you can sustainably replenish. Over time, your system doesn’t just get tired—it starts to shut down as a form of self-protection.

What Burnout Feels Like

Burnout often shows up as chronic fatigue, cynicism, irritability, brain fog, or a sense of emotional numbness. You might feel detached from your work or relationships, find it harder to care about things that once mattered, or feel trapped in a loop of obligation without relief. Many people also experience physical symptoms: headaches, muscle tension, sleep problems, or increased illness.

One reason burnout is so common is that our culture rewards overcommitment. We glorify productivity, hustle, and resilience while quietly discouraging rest and limits. Many people treat life like a series of sprints—constantly rushing, pushing, and accelerating—when in reality, a sustainable life is more like a marathon. Sprinting occasionally is fine. Sprinting all the time is not.

Spoon Theory and the Cost of Overcommitting

A helpful framework for understanding burnout is spoon theory. Originally developed to describe chronic illness, spoon theory uses “spoons” as a metaphor for energy units. Each task—getting dressed, going to work, having a conversation—costs a certain number of spoons. When you’re out of spoons, you’re done for the day.

Burnout often develops when we repeatedly plan our lives as if we have unlimited spoons. We say yes to too much, underestimate the energy cost of obligations, and assume tomorrow we’ll magically have more capacity. Overcommitting—whether at work, in family roles, or socially—drains spoons faster than they can be replenished. Recovery requires learning to budget energy realistically, not optimistically.

Recovery Is Not a Vacation—It’s a Recalibration

Recovering from burnout isn’t just about taking a break, though breaks help. Many people take time off only to return to the same patterns, expectations, and internal pressures that caused burnout in the first place. True recovery requires both rest and structural change.

Here are five strategies that can support healing and help prevent burnout from returning.

1. Shift from Sprinting to Pacing

Burnout recovery begins with changing how you move through life. If you’ve been living in constant urgency, your nervous system is likely stuck in overdrive. Pacing means intentionally slowing down, building in margins, and leaving some energy unused.

This may feel uncomfortable at first, especially if your identity is tied to productivity. But pacing doesn’t mean doing nothing—it means doing what’s sustainable. Ask yourself: Could I keep living this way for years? If the answer is no, something needs to change.

2. Reassess Commitments and Say Fewer Yeses

Burnout thrives on unexamined obligation. Recovery requires a hard look at where your energy is going. Which commitments are essential, and which are inherited, habitual, or guilt-driven?

Start by reducing, not optimizing. You don’t need a more efficient schedule—you need a lighter one. Practice saying no, postponing decisions, or offering partial participation. Protecting your energy is not selfish; it’s necessary.

3. Restore Rest (Without Earning It)

Many burned-out people only rest when they feel they’ve “earned” it. Recovery asks you to flip that belief. Rest is not a reward—it’s a biological requirement.

This includes sleep, but also mental rest (less stimulation), emotional rest (fewer draining interactions), and sensory rest (quiet, nature, reduced screen time). Rest may feel unproductive, but it is the soil where recovery grows.

4. Reconnect with Meaning, Not Just Output

Burnout often strips life of meaning, leaving only tasks and expectations. Part of healing involves reconnecting with why you do what you do—or discovering new sources of meaning altogether.

This might involve creativity, values-based work, relationships, spirituality, or small moments of pleasure and curiosity. Meaning doesn’t have to be grand. It just has to be yours.

5. Seek Support and Normalize Needing Help

Burnout is not a personal failure; it’s a human response to chronic strain. Talking with a therapist, counselor, or trusted person can help you untangle unrealistic expectations, perfectionism, or people-pleasing patterns that fuel burnout.

Support also reminds you that you don’t have to carry everything alone. Recovery is faster—and gentler—when it’s shared.

Moving Forward

Burnout recovery is not linear. There will be days when energy returns, and days when it doesn’t. The goal is not to get back to who you were before burnout, but to build a life that doesn’t require burning yourself down to function.

When you stop treating life like an endless sprint, honor your limited spoons, and allow rest to be part of the plan, something important happens: energy slowly comes back—not as adrenaline, but as steadiness. And that kind of energy lasts.

Therapy

Challenging Perfectionism

S. Reimers, JD/LICSW

Learning to Be Okay with Being Human

Perfectionism often disguises itself as motivation. It whispers that we’re only as good as our latest achievement, our cleanest home, our most flawless performance. At first, it can seem like a drive toward excellence. But over time, perfectionism becomes less about doing well and more about avoiding failure — or the feeling of being “not enough.” It can keep us trapped in cycles of anxiety, self-criticism, and emotional exhaustion.

Learning to challenge perfectionism isn’t about lowering your standards; it’s about freeing yourself from the belief that you must be flawless to be worthy. It’s about learning to live, breathe, and even thrive in the presence of imperfection — your own and the world’s.

Recognize the Voice of Perfectionism

The first step is noticing when perfectionism is speaking. Its voice often sounds like:

  • “If I can’t do it perfectly, it’s not worth doing.”
  • “Everyone else is doing better than me.”
  • “I should have known better.”
  • “If I make a mistake, people will see I’m not good enough.”

Try writing these thoughts down as they arise. Seeing them on paper creates distance between you and them. These aren’t objective truths; they’re stories you’ve learned to tell yourself. Ask: Whose standards am I trying to meet? and What am I afraid would happen if I didn’t meet them?

Naming perfectionism gives you power to challenge it.

Redefine What “Good Enough” Means

Perfectionism operates on extremes — success or failure, right or wrong, perfect or worthless. Real life lives in the gray area.

To soften perfectionism’s grip, begin redefining what “good enough” looks like in your daily life. That might mean:

  • Finishing a project when it meets its purpose, not when it feels flawless.
  • Showing up to a social event even if you’re not feeling your best.
  • Sending the email even if the wording isn’t poetic.

You might even make a “Good Enough List”: write down specific examples of tasks that don’t need to be perfect — meals, chores, emails, workouts, conversations. Each time you accept “good enough,” you strengthen the muscle of self-acceptance.

Try saying to yourself:

“I can do things imperfectly and still be proud of myself.”
“Progress counts more than perfection.”
“Done is better than perfect.”

These aren’t excuses for laziness; they’re affirmations of humanity.

Build Comfort with Mistakes

Mistakes don’t define your worth — they reveal your growth edges.

When you make a mistake, try shifting from self-criticism to curiosity. Instead of “I’m so stupid,” say,

“That didn’t go the way I hoped. What can I learn from it?”

Curiosity is the antidote to shame. It transforms “I failed” into “I learned.” Over time, this practice rewires the emotional association between mistakes and self-worth. Instead of spiraling into self-rejection, you learn to meet mistakes with patience and compassion.

Another tool: imagine talking to a close friend who made the same mistake. You’d likely say, “It’s okay — you’re human. You’ll figure it out.” Try saying that to yourself, even if it feels awkward at first.

Self-talk might sound like:

“It’s safe for me to be learning.”
“I’m still growing, and that’s what matters.”
“Making mistakes doesn’t make me a failure — it makes me real.”

Practice Imperfect Action

Perfectionism thrives on delay — waiting until you feel ready, certain, or “good enough.” The antidote is imperfect action.

Choose something small: share a creative project before you think it’s ready. Try a new recipe without overplanning. Speak up even if your voice shakes. Each act of imperfect action is a quiet rebellion against perfectionism’s tyranny.

The goal isn’t to fail intentionally — it’s to act without the guarantee of perfection. Over time, you’ll build tolerance for uncertainty and learn that your worth doesn’t depend on outcomes.

You can remind yourself:

“It’s better to try imperfectly than to not try at all.”
“Every step forward counts, even if it’s messy.”

Imperfect action builds confidence through lived experience, not imagined mastery.

Develop a Kinder Inner Voice

Perfectionism often grows from an inner critic that once tried to protect you — maybe from disapproval, rejection, or shame. But as adults, we can replace that harsh voice with one that supports growth instead of fear.

Positive self-talk isn’t about empty affirmations; it’s about re-parenting the part of you that feels unsafe being imperfect.

When you notice the critic saying, “You’re not good enough,” respond gently:

“I’m doing my best, and that’s enough for today.”

When it says, “You messed up again,” try:

“It’s okay to be learning. I can still be kind to myself.”

If it says, “People won’t like you if you fail,” answer:

“I’m allowed to be real. People connect with honesty, not perfection.”

Write a few affirmations that resonate with you and keep them visible — on your phone background, a sticky note, or your mirror. Over time, your brain learns to reach for kindness first.

6. Embrace Humanity Over Performance

Perfectionism teaches us to perform — to prove we’re deserving. But connection doesn’t come from being impressive; it comes from being authentic. When you allow yourself to be imperfect, you give others permission to do the same.

Notice how your relationships feel when you drop the façade, when you say, “I don’t know,” or “I’m struggling.” Vulnerability can be deeply uncomfortable — but it’s also deeply freeing.

You might remind yourself:

“I am lovable, not because I’m perfect, but because I’m human.”

Closing Thought

Challenging perfectionism isn’t about giving up on growth — it’s about reclaiming the right to grow freely. It’s learning that your worth is inherent, not earned through flawless performance.

When you make peace with imperfection, you stop chasing a moving target and start living your real, messy, beautiful life. You begin to realize: the cracks in you were never flaws — they were openings for light to get in.

Therapy

Cognitive Defusion: A Key to Psychological Flexibility

S. Reimers, JD/LICSW

Part Two of a Six Part Series on the Core Principles of ACT Therapy

Changing Your Relationship with Thoughts

This post is the second in our series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to enhance psychological flexibility and promote a values-driven life. Following our discussion of Acceptance, we now turn to another foundational principle of the ACT hexaflex: Cognitive Defusion.

What Is Cognitive Defusion in ACT?

Cognitive defusion is the process of changing how we relate to our thoughts. In ACT, thoughts are not viewed as inherently good or bad, true or false. Instead, the focus is on how much power we give to these thoughts and whether they help us live according to our values. Cognitive defusion involves stepping back from thoughts, seeing them for what they are—simply words or images in our minds—rather than as literal truths that must dictate our actions or emotions.

When we become fused with our thoughts, we treat them as absolute facts and allow them to dominate our decisions and behaviors. Defusion helps us break free from this grip, enabling us to observe our thoughts with curiosity and perspective. By doing so, we can reduce their impact and influence, allowing us to act in alignment with our values rather than being controlled by unhelpful mental content.

Why Is Cognitive Defusion Important?

Cognitive defusion is crucial because it helps us disentangle from thought patterns that contribute to emotional distress and behavioral avoidance. Many psychological struggles, such as anxiety, depression, and low self-esteem, are fueled by unhelpful thinking. When we take our thoughts too seriously or treat them as ultimate truths, we can become stuck in patterns of rumination, worry, or self-criticism.

Defusion allows us to create distance from these thoughts, diminishing their power and influence. It helps us see that thoughts are not commands we must obey or obstacles we must eliminate. Instead, they are transient experiences that we can observe and let pass without getting caught up in their content. This shift empowers us to make choices based on our values rather than being driven by automatic thought patterns.

Cognitive Defusion in Action: A Metaphor

One of the most well-known metaphors for cognitive defusion is the “Passengers on the Bus” metaphor. Imagine you are driving a bus, and the passengers represent your thoughts. Some passengers are loud, critical, or demanding, while others are quiet or supportive. If you stop the bus every time a passenger yells at you, you won’t make much progress toward your destination. Cognitive defusion teaches you to keep driving the bus, acknowledging the passengers’ presence but not letting them dictate your journey.

Practical Strategies to Cultivate Cognitive Defusion

In ACT, cognitive defusion is a skill that can be practiced and developed. Here are some techniques to help you foster this skill:

  1. Labeling Thoughts: Practice noticing your thoughts and labeling them as they arise. For example, instead of thinking, “I’m a failure,” you might say, “I’m having the thought that I’m a failure.” This simple shift creates distance and reminds you that thoughts are not facts.
  2. Silly Voices Exercise: Repeat a troubling thought in a silly voice or imagine it being said by a cartoon character. This exercise highlights the arbitrary nature of thoughts and reduces their emotional impact.
  3. Thought Clouds: Visualize your thoughts as clouds drifting across the sky. Notice them come and go without trying to hold onto or push them away. This imagery reinforces the idea that thoughts are temporary and not inherently powerful.
  4. Leaves on a Stream: Imagine placing each thought on a leaf and letting it float down a stream. Watch as the leaf drifts away, carrying the thought with it. This technique helps you practice letting go of unhelpful thoughts.
  5. Thank Your Mind: When your mind produces a particularly challenging thought, try saying, “Thank you, mind,” with a touch of humor or kindness. This response acknowledges the thought’s presence without becoming entangled in it.

Common Misconceptions About Cognitive Defusion

It is important to clarify what cognitive defusion is and what it is not:

  • Defusion Is Not Suppression: Defusion does not involve pushing thoughts away or trying to eliminate them. Instead, it involves changing your relationship with them.
  • Defusion Is Not Distraction: While defusion techniques may reduce the immediate impact of a thought, their primary goal is to foster awareness and perspective, not to avoid or distract from the thought.
  • Defusion Is Not About Truth: The goal is not to determine whether a thought is true or false but to assess whether it is helpful and aligned with your values.

The Role of Cognitive Defusion in the ACT Hexaflex

Cognitive defusion is closely connected to other principles of the ACT hexaflex, such as mindfulness and acceptance. Together, these principles create a flexible approach to managing difficult thoughts and emotions while pursuing a meaningful life. By practicing defusion, you can increase your ability to stay present, act intentionally, and focus on what matters most.

Final Thoughts

Cognitive defusion is a transformative skill that allows us to step back from our thoughts and see them for what they are: fleeting mental events rather than absolute truths. By cultivating this skill, we can reduce the power of unhelpful thinking and make choices that align with our values and goals.

In the next post in this series, we will explore the principle of Present Moment Awareness, which builds on the concepts of acceptance and defusion to help us engage more fully with life. For now, consider how cognitive defusion might apply to your own experiences. How might your life change if you could view your thoughts with greater curiosity and detachment? The journey to greater psychological flexibility starts with small steps like these.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Acceptance: Greeting Life Without Judgment

S. Reimers, JD/LICSW

Part One in a Six Part Series on the Core Principles of ACT Therapy

Embracing Life as It Is

This post is the first in a series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to help individuals build a meaningful and values-driven life. ACT is structured around six interrelated principles, often visualized as a hexaflex. These principles work together to cultivate psychological flexibility, a key component of well-being. In this series, we begin with one of the foundational principles: Acceptance.

What Is Acceptance in ACT?

Acceptance in ACT is not about passive resignation or giving up. Rather, it is an active process of opening up to our inner experiences—thoughts, emotions, memories, and sensations—without judgment or attempts to avoid, suppress, or control them. It is the practice of making room for these experiences, even when they are uncomfortable, while continuing to engage with life in meaningful ways.

At its core, acceptance challenges the natural human tendency to fight against discomfort or unpleasant emotions. In modern society, we are often taught to “fix” problems, avoid pain, and pursue happiness at all costs. While this approach can be helpful in many contexts, it becomes problematic when applied to our internal world. Struggling against pain often amplifies suffering, creating a cycle of avoidance and distress that prevents us from living fully.

Why Is Acceptance Important?

Acceptance is vital because it frees us from the exhausting battle of trying to control what we cannot. Many psychological struggles stem from attempts to avoid difficult emotions or thoughts, a process known as experiential avoidance. While avoidance may bring short-term relief, it often leads to long-term problems, such as anxiety, depression, addiction, or a diminished sense of meaning in life.

When we practice acceptance, we learn to approach our internal experiences with curiosity and compassion rather than fear or aversion. This shift allows us to respond more effectively to life’s challenges, enabling us to focus our energy on what truly matters. Importantly, acceptance does not mean liking or approving of painful experiences. It simply means acknowledging their presence without allowing them to dominate our lives.

Acceptance in Action: A Metaphor

A powerful metaphor used in ACT to explain acceptance is the “struggle with quicksand.” Imagine you are trapped in quicksand. Your first instinct might be to struggle and thrash in an effort to escape. However, this reaction only causes you to sink deeper. The way out is counterintuitive: stop struggling, spread your weight evenly, and allow yourself to float. Similarly, acceptance involves letting go of the struggle with difficult emotions and thoughts, creating the space to move forward.

Practical Strategies to Cultivate Acceptance

In ACT, acceptance is not just a concept but a skill that can be developed through practice. Here are some strategies to help cultivate acceptance in daily life:

  1. Mindful Observation: Practice noticing your thoughts and emotions as they arise, without labeling them as “good” or “bad.” For example, if you feel anxious, simply acknowledge, “I am noticing anxiety right now.” This nonjudgmental awareness helps create distance from the experience, reducing its intensity.
  2. Allowing and Breathing: When faced with a challenging emotion, pause and take a few deep breaths. Visualize yourself creating space for the emotion, allowing it to be there without resistance. Remember that emotions, like waves, will naturally rise and fall if you let them.
  3. Anchoring in the Present: Engage your senses to ground yourself in the present moment. Focus on the feel of the ground beneath your feet, the sound of birds chirping, or the sensation of your breath entering and leaving your body. This practice can help you stay present rather than getting caught up in avoidance.
  4. Self-Compassion: Speak to yourself with kindness and understanding, especially during difficult times. Remind yourself that it’s okay to feel pain and that you are not alone in your struggles. Self-compassion can soften resistance and create a safe space for acceptance.
  5. Acceptance Imagery: Imagine your thoughts and emotions as leaves floating down a stream or clouds passing across the sky. This imagery can help you see them as temporary and separate from your core self, reducing the urge to control or suppress them.

Common Misconceptions About Acceptance

It is important to address some common misunderstandings about acceptance:

  • Acceptance Is Not Endorsement: Accepting an experience does not mean you agree with it or want it to continue. It simply means you are choosing to stop fighting against its presence.
  • Acceptance Is Not Passive: Acceptance is an active stance. It requires courage and effort to turn toward discomfort and make space for it.
  • Acceptance Does Not Replace Action: Acceptance works hand-in-hand with committed action. While you make room for difficult experiences, you also take steps aligned with your values and goals.

The Role of Acceptance in the ACT Hexaflex

Acceptance is intricately linked with the other principles of the ACT hexaflex, such as mindfulness, cognitive defusion, and values-based action. Together, these principles create a framework for navigating life’s challenges with greater flexibility and resilience. By practicing acceptance, you lay the foundation for engaging more fully with the present moment and pursuing a meaningful life.

Final Thoughts

Learning to embrace acceptance is a transformative journey. It allows us to let go of the struggle with pain and focus on what truly matters: living in alignment with our values. In the next post in this series, we will delve into the principle of cognitive defusion, another essential component of the ACT model.

For now, consider how acceptance might play a role in your life. What would it feel like to stop fighting against difficult emotions or thoughts and instead make space for them? The path to greater well-being often begins with this simple yet profound shift.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

LGBT, Political, Therapy, Transgender

The Truth About Gender-Affirming Care

S. Reimers, JD/LICSW

Countering the Mischaracterization of Trans Healthcare

A recent study published in JAMA Pediatrics reveals an important yet often overlooked fact about transgender healthcare in the United States: a “very, very small number” of teens receive gender-affirming medical care. This finding underscores the reality that much of the rhetoric surrounding transgender youth is rooted not in evidence but in sensationalism. Despite claims to the contrary, doctors and mental health professionals who follow the World Professional Association for Transgender Health (WPATH) standards are not “grooming” children. Instead, they are providing thoughtful, evidence-based care that often involves slowing down the decision-making process and exploring various options.

What the Study Tells Us

The study, which analyzed private insurance claims for over 5 million adolescents from 2018 to 2022, found that fewer than 18,000 teens were diagnosed with gender dysphoria during this period. Even more strikingly, fewer than 1,000 accessed puberty blockers, and fewer than 2,000 received hormone therapy. In total, this represents less than 0.1% of teenagers with private insurance.

These numbers stand in stark contrast to the political narrative that frames gender-affirming care as a widespread and reckless phenomenon. Instead, the data reveals that such care is exceedingly rare and highly specialized. Moreover, many transgender youth do not pursue medical interventions at all, opting instead for non-medical changes like adopting a new name or altering their clothing and hairstyle.

A Thoughtful and Cautious Process

The standards of care set forth by WPATH emphasize a thorough, patient-centered approach to gender-affirming care. This process often begins with mental health evaluations and discussions aimed at helping young people explore their gender identity in a safe and supportive environment. Puberty blockers, for instance, are reversible treatments that give adolescents more time to consider their options before making permanent decisions.

Contrary to the inflammatory claims of critics, these interventions are not rushed or taken lightly. Decisions about puberty blockers and hormones are typically made after careful consideration, involving not just the patient but also their family and healthcare team. This aligns with WPATH guidelines, which prioritize the well-being of the individual and recommend age-appropriate care based on robust scientific evidence.

Mischaracterizing Trans Healthcare

Despite the thoughtful nature of gender-affirming care, it has been severely mischaracterized in public discourse. Opponents often portray it as experimental or dangerous, ignoring endorsements from major medical organizations like the American Academy of Pediatrics and the American Medical Association. These groups recognize that access to gender-affirming care can significantly improve mental health outcomes for transgender youth, including reducing rates of depression, anxiety, and suicidal ideation.

The political weaponization of trans healthcare has also led to widespread misinformation. For example, opponents frequently conflate gender-affirming care with irreversible surgeries on minors—a practice that is exceedingly rare and not recommended under WPATH standards for adolescents. Instead, the focus is on non-invasive or reversible treatments designed to provide support during a critical developmental period.

The Disproportionate Focus on Trans Youth

The study’s findings also highlight the disproportionate attention given to transgender youth in political and media discourse. While fewer than 0.1% of teens with private insurance receive gender-related medical care, this small group has become the target of legislative efforts in half of U.S. states. These efforts often ignore the lived experiences of transgender individuals and the consensus of medical professionals in favor of divisive political messaging.

This focus is not only unwarranted but also harmful. Transgender youth already face significant challenges, including higher rates of bullying, discrimination, and mental health struggles. The stigmatization of gender-affirming care exacerbates these issues, creating barriers to accessing supportive and life-affirming treatment.

Slowing Down to Support

Far from “pushing” children into irreversible decisions, providers who adhere to WPATH standards often help young people slow down and consider their options. This approach reflects the core principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. By creating a space for open dialogue and careful deliberation, healthcare professionals empower patients and their families to make informed decisions based on their unique needs and circumstances.

Moreover, delaying or banning access to gender-affirming care does not eliminate the need for support—it merely shifts the burden onto already vulnerable populations. Denying care increases the risk of negative mental health outcomes, as individuals are forced to navigate their identities without the tools and resources they need to thrive.

The Path Forward

As debates about transgender healthcare continue, it is essential to center evidence and compassion over fear and misinformation. The findings from the JAMA Pediatrics study remind us that gender-affirming care is not a widespread or reckless practice—it is a rare, carefully considered intervention that helps young people navigate their identities with dignity and support.

Rather than demonizing healthcare providers and transgender youth, policymakers and the public should strive to understand the realities of gender-affirming care. This means listening to medical experts, uplifting the voices of transgender individuals, and rejecting the harmful narratives that misrepresent their experiences.

By doing so, we can move toward a more inclusive and compassionate society—one that recognizes the humanity of all its members and ensures that everyone has access to the care they need to live authentically.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Understanding Acceptance and Commitment Therapy

S. Reimers, JD/LICSW

Embracing Life’s Challenges with Mindful, Values-Based Commitments

Acceptance and Commitment Therapy (ACT), pronounced as “act” rather than spelled out, represents a groundbreaking approach in the field of psychotherapy. Rooted in the principles of mindfulness, behavioral science, and acceptance, ACT encourages individuals to embrace life’s challenges rather than resist them. This philosophy aims to foster psychological flexibility, empowering people to live meaningful lives even in the face of adversity.

The Core Philosophy of ACT

ACT is grounded in the belief that psychological suffering arises from the human tendency to avoid or suppress difficult emotions, thoughts, and experiences. At its heart, ACT challenges the conventional goal of eliminating distress, arguing instead that it is our relationship with discomfort—not the discomfort itself—that determines our mental well-being.

The therapy is deeply influenced by Relational Frame Theory (RFT), a modern behavioral science framework that explores how language and cognition influence our behavior. RFT posits that humans are uniquely capable of forming complex associations through language, which, while advantageous, can also lead to cognitive traps such as self-criticism, worry, and avoidance.

ACT emphasizes six interconnected processes that form its therapeutic foundation, often visualized as the points of a hexagon, collectively referred to as the ACT Hexaflex. These processes work in harmony to cultivate psychological flexibility, the ability to stay present, open, and committed to value-driven action even when faced with challenging emotions or thoughts.

The Six Core Processes of ACT

1. Acceptance

Acceptance involves an active and open stance toward difficult thoughts, emotions, and sensations rather than attempting to suppress, control, or avoid them. ACT posits that fighting against unpleasant experiences often amplifies suffering. Instead, acceptance fosters a willingness to coexist with discomfort, recognizing it as a natural part of life.

For instance, rather than avoiding anxiety-provoking situations, an individual learns to acknowledge and make room for the anxiety, allowing them to engage more fully with life.

2. Cognitive Defusion

Cognitive defusion refers to the process of disentangling from unhelpful thoughts and seeing them for what they are—words and images—rather than absolute truths. This practice helps reduce the power and influence of negative thinking.

A common exercise involves imagining a distressing thought as a cloud floating across the sky or writing it on a leaf carried down a stream. These metaphors encourage clients to observe their thoughts from a distance rather than becoming entangled in them.

3. Present Moment Awareness

Mindfulness lies at the heart of ACT, emphasizing non-judgmental awareness of the present moment. This practice encourages individuals to fully experience their surroundings, sensations, and emotions without judgment or distraction.

Present moment awareness helps individuals break free from the grip of past regrets or future anxieties, grounding them in the here and now. Techniques such as mindful breathing, body scans, and sensory awareness exercises are commonly employed to cultivate this skill.

4. Self-as-Context

ACT introduces the concept of “self-as-context,” which differentiates between the “self” as a constant, observing entity and the transient thoughts, feelings, and roles we often associate with our identity. By recognizing that they are more than their thoughts or emotions, individuals can gain perspective and reduce the impact of self-limiting beliefs.

For example, instead of saying, “I am a failure,” an individual might reframe it as, “I notice that I am having the thought that I am a failure.” This subtle shift creates space for self-compassion and empowerment.

5. Values Clarification

ACT emphasizes the importance of identifying and living in alignment with one’s core values. Values are the guiding principles that give life meaning and purpose, such as kindness, creativity, or community involvement. Therapy often involves exercises to help individuals clarify what truly matters to them, serving as a compass for decision-making and goal-setting.

Rather than focusing on symptom reduction, ACT asks, “What do you want your life to stand for?” This shift encourages individuals to focus on what they can control: taking steps toward a fulfilling and values-driven life.

6. Committed Action

Once values are clarified, ACT encourages committed action—taking meaningful steps toward living those values, even in the face of obstacles. This process involves setting realistic goals, developing action plans, and building resilience to persist despite setbacks.

For instance, a person who values connection might commit to reaching out to a friend despite feelings of social anxiety. Over time, these actions build momentum, fostering a sense of agency and purpose.

The Unique Approach of ACT

What sets ACT apart from other therapeutic modalities is its emphasis on acceptance over avoidance and its integration of mindfulness into practical, action-oriented strategies. Unlike Cognitive Behavioral Therapy (CBT), which often focuses on challenging and changing unhelpful thoughts, ACT encourages clients to change their relationship with their thoughts. This distinction shifts the focus from controlling internal experiences to engaging meaningfully with external ones.

Another hallmark of ACT is its use of metaphors, experiential exercises, and storytelling to convey complex ideas. For example:

  • The Tug-of-War Metaphor: Imagine you’re in a tug-of-war with a monster (representing your struggles), and there’s a pit in the middle. The harder you pull, the more the monster pulls back. ACT suggests letting go of the rope—not to surrender but to stop exhausting yourself in a battle that keeps you stuck.
  • Passengers on the Bus: In this metaphor, you are the driver of a bus, and your thoughts, emotions, and fears are the passengers. While some passengers may be loud and unpleasant, they don’t control the direction of the bus—you do.

Evidence Base and Applications

ACT has been extensively researched and shown to be effective for a wide range of psychological and physical conditions, including:

  • Anxiety disorders
  • Depression
  • Chronic pain
  • Substance use disorders
  • PTSD
  • Obsessive-compulsive disorder (OCD)

Additionally, ACT is increasingly applied in workplace settings, coaching, and education, demonstrating its versatility and relevance.

Challenges and Critiques

While ACT has gained widespread acceptance, it is not without its critics. Some argue that its concepts can be abstract or difficult to grasp for clients who prefer structured, problem-solving approaches. Additionally, practitioners must strike a balance between acceptance and action, ensuring clients do not become passive in the face of challenges.

Conclusion

Acceptance and Commitment Therapy offers a transformative approach to psychological well-being by teaching individuals to embrace life’s inevitable challenges while staying true to their values. By fostering acceptance, mindfulness, and committed action, ACT helps people navigate their internal experiences with greater flexibility and resilience.

Ultimately, ACT is not about eliminating pain but about creating space for a rich, meaningful life—a life in which discomfort is not a barrier but a companion on the journey toward growth and fulfillment.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Legal, LGBT, Political, Therapy, Transgender

Debunking Rapid Onset Gender Dysphoria: Key Findings

S. Reimers, JD/LICSW

Addressing the One Controversial Theory Fueling Anti-Trans Legislation

In the ever-evolving conversation surrounding gender diversity, research provides critical insights to guide compassionate and evidence-based understanding. A 2022 study published in Pediatrics by Jack L. Turban and colleagues challenges the controversial “Rapid Onset Gender Dysphoria” (ROGD) hypothesis, which posits that social contagion and peer influence drive sudden transgender identification among adolescents. This study’s findings highlight the resilience of transgender and gender-diverse (TGD) youth and underscore the importance of supporting their well-being through gender-affirming care.

Study Overview

The research examined the assigned-at-birth sex ratios and experiences of TGD adolescents using data from school-based surveys conducted across 16 U.S. states in 2017 and 2019. The study’s objectives included evaluating trends in TGD identification, exploring whether social contagion disproportionately affects certain groups, and addressing myths about the motivations behind identifying as TGD. By analyzing responses from a large, diverse sample, the researchers aimed to separate fact from speculation about the lived experiences of TGD youth.

Key Findings

  1. Sex Assigned at Birth Ratios
    The study found that in both 2017 and 2019, there were more assigned-male-at-birth (AMAB) TGD adolescents than assigned-female-at-birth (AFAB) TGD adolescents. This challenges the ROGD hypothesis, which claims that AFAB youth are uniquely susceptible to social contagion driving TGD identification.The slight shift in ratios over time, attributed to fewer AMAB TGD participants rather than an increase in AFAB TGD participants, further debunks claims of an AFAB-specific phenomenon. These findings contradict the idea that peer or social influences are creating clusters of transgender identification among AFAB youth.
  2. Bullying and Mental Health Challenges
    TGD youth were significantly more likely than cisgender peers to experience bullying and mental health struggles, including suicide attempts. The rates of bullying were higher for TGD youth than even for cisgender sexual minority youth. These patterns highlight the vulnerability of TGD adolescents to external stigma and the critical need for supportive environments.The data also counters the assertion that identifying as TGD offers a social advantage or serves as a way to escape sexual minority stigma. Instead, many TGD youth also identified as gay, lesbian, or bisexual, underscoring that their experiences with stigma are compounded rather than reduced.
  3. A Decrease in TGD Identification Over Time
    The percentage of adolescents identifying as TGD decreased from 2.4% in 2017 to 1.6% in 2019. This decline contradicts the notion of a social contagion effect driving exponential increases in TGD identification. If social contagion were at play, one would expect a steady or growing trend rather than a decrease.
  4. Debunking the ROGD Hypothesis
    The study directly refutes claims central to the ROGD hypothesis: that social influences uniquely drive AFAB youth toward TGD identification and that these identifications result from peer pressure or efforts to gain social status. By leveraging robust, population-based data, the researchers demonstrated that these narratives lack empirical support.

The Importance of Gender-Affirming Care

One of the most critical implications of this study is its support for gender-affirming medical care. Myths such as ROGD have been weaponized in legislative debates to deny TGD adolescents access to care, despite overwhelming evidence from major medical organizations that such care improves mental health outcomes. The researchers emphasize that restricting access to gender-affirming care based on unfounded hypotheses is not only scientifically unsound but also harmful to the well-being of TGD youth.

A n Affirming Perspective

This study reinforces that TGD youth deserve acceptance, support, and access to life-affirming care. The persistence of stigma and misinformation, such as the ROGD hypothesis, underscores the importance of amplifying evidence-based narratives that respect the lived experiences of transgender individuals. Rather than questioning the validity of TGD identities, society should focus on addressing the systemic factors—like bullying and discrimination—that harm these adolescents.

Ultimately, this research affirms that TGD youth are not merely responding to fleeting social trends or peer influences. They are navigating complex identities in a world that often misunderstands them. By creating a society grounded in empathy, evidence, and inclusion, we can empower these young people to thrive authentically.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Overcoming Seasonal Affective Disorder (SAD) This Winter

S. Reimers, JD/LICSW

Tips for Coping with a Case of the Winter Blues

As the vibrant colors of autumn fade into muted shades of gray and white, winter begins to assert itself, typically starting in late December and extending through late March. For those in the northern parts of the country, this season brings its unique challenges. The days grow alarmingly short, with the sun rising late and setting as early as mid-afternoon. Cold temperatures and icy conditions make outdoor activities less inviting, while snow-covered landscapes, though beautiful, can feel isolating. These seasonal changes often lead to a phenomenon many refer to as the “winter blues.”

The winter blues, also known as seasonal affective disorder (SAD) in its more severe forms, can leave you feeling lethargic, unmotivated, and even depressed. This is a widespread issue, with millions experiencing a dip in their mental health during these colder months. But understanding why this happens and exploring ways to counteract it can make winter a more manageable, even enjoyable, time of year.

Why Does Winter Impact Our Mood?

The primary culprit behind the winter blues is the lack of sunlight. Sunlight plays a crucial role in regulating our circadian rhythms, the internal clock that governs our sleep-wake cycle. Reduced exposure to daylight can disrupt this rhythm, leading to fatigue and difficulty concentrating. Additionally, limited sunlight can decrease serotonin levels—a neurotransmitter that contributes to feelings of well-being—and increase melatonin production, which can make us feel sleepy and sluggish.

Another contributing factor is the limited opportunity for outdoor activities and social connection. In warmer months, it’s easier to meet friends for a walk, enjoy a picnic, or take part in community events. But when temperatures plummet and sidewalks are slick with ice, many people opt to stay indoors, leading to feelings of isolation. The festive holiday season, while joyful for some, can exacerbate feelings of loneliness for others, especially once the celebrations are over and January’s stark reality sets in.

Fighting Back: Strategies to Beat the Winter Blues

Although winter’s challenges are real, there are numerous strategies you can employ to lift your spirits and maintain your mental health during the colder months. Here are some effective ways to combat the winter blues:

1. Maximize Sunlight Exposure

Whenever possible, try to get outside during daylight hours. Even a short walk during your lunch break can make a difference. If natural light is scarce, consider investing in a light therapy box. These devices mimic natural sunlight and can help regulate your circadian rhythms, boost serotonin levels, and improve your mood. Place the light box on your desk or dining table and use it for about 20-30 minutes each morning for optimal results.

2. Stay Active

Exercise is a powerful mood booster. While outdoor activities may be less accessible, there are plenty of ways to stay active indoors. Join a gym, try yoga or Pilates at home, or explore online workout classes. If you’re an outdoor enthusiast, consider winter-friendly activities like snowshoeing, cross-country skiing, or even brisk walks on clearer days. Physical activity releases endorphins, which are natural stress relievers and mood enhancers.

3. Prioritize Social Connections

Combat isolation by staying connected with friends and family. Schedule regular phone calls, video chats, or socially distanced meetups. If it’s safe and feasible, host small gatherings or join virtual communities and groups that share your interests. Social interaction is a cornerstone of mental well-being, and making an effort to connect can help you feel less alone.

4. Maintain a Healthy Routine

Establishing a consistent daily routine can provide structure and a sense of normalcy during the darker months. Aim to wake up and go to bed at the same time every day to support your circadian rhythm. Eat a balanced diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains. Foods rich in omega-3 fatty acids, like salmon and walnuts, as well as those high in vitamin D, can be particularly beneficial.

5. Practice Mindfulness and Gratitude

Mindfulness techniques, such as meditation and deep breathing, can help reduce stress and improve your overall mental state. Take a few minutes each day to sit quietly and focus on your breath or practice guided meditations. Gratitude journaling is another effective tool; write down three things you’re thankful for each day to shift your perspective and cultivate positivity.

6. Seek Professional Help if Needed

If your feelings of sadness or lethargy persist and interfere with your daily life, don’t hesitate to seek help from a mental health professional. Therapy, medication, or a combination of both can be highly effective for managing seasonal affective disorder. Remember, asking for help is a sign of strength, not weakness.

Embracing the Season

While winter may not be everyone’s favorite season, finding ways to embrace its unique offerings can make a significant difference. Cozy up with a good book by the fire, explore new indoor hobbies like painting or baking, or take time to reflect and plan for the year ahead. Viewing winter as an opportunity for rest and rejuvenation, rather than a burden, can shift your mindset and help you make the most of this quieter season.

Winter’s challenges are undeniable, but with intentional effort and a proactive approach, it’s possible to not just survive but thrive during these colder, darker months. By staying active, connected, and mindful, you can keep the winter blues at bay and emerge into spring feeling strong and refreshed.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW