Writing about mental health from a feminist counselling perspective
June is Migraine and Headache Awareness Month here in Canada, an opportunity to raise awareness through education and research on the nature and impact of headache and migraine disorders, as well as support and advocate for people living with this type of chronic pain. For those of you who might not know, I have a personal history in dealing with migraines. I’ve always had them but, a few years ago, chronic stress and burnout led to daily, high intensity migraines that wouldn’t go away. Since then, things have improved for me, but as a chronic pain condition, this is something I have to live with. Here are 4 things I’ve been doing to navigate migraines in the last year:
1. Neurologist care
I’ve been getting by pretty well with the support of my GP, but back in September we decided that if I’m going to try one of the injectable migraine treatments, I really needed to talk to someone who was an expert in the area. In Edmonton, this is Dr. Michael Knash, a neurologist who specializes in migraine and headache. He was able to assist immediately with finding the right dose and sharing with me some options for getting medication coverage.
One thing that I was surprised to learn is that not all neurologists have the same training or expertise, so it's important to find one who specifically works with migraine. You can watch this video from the Pain Society of Alberta where he talks about options for treating your migraine attacks at home.
2. Therapist support
Fortunately, my existing therapist has experience working with migraine . I’m so grateful that she’s able to have direct conversations with me about therapy, pain, and when I’m holding unrealistic expectations about what my relationship with chronic pain should be.
She also reminded me that stress is a part of life, and if my plan included never being stressed, it wasn’t going to work. We’re both big advocates that migraine treatments should work despite the daily stressors of living in Alberta, being a parent, and being a therapist. Her reminder to me was that treatment of chronic pain is a gendered issue and that I needed to go back to my doctor if my current medication was no longer working. This was also a reminder that what works for a while in terms of treatment may not always work, and if severity or frequency of pain increases, it’s a good idea to revisit medications and treatment plans.
3. Guided visualizations
I continued to use the guided visualizations from Curable Health. Curable is an online program and app that provides professional help to people living with persistent or chronic pain. They use a biopsychosocial approach that addresses pain from multiple angles (psychical, psychological, and emotional) to provide science-backed lessons and techniques.
My favorite is the control room visualization, where you turn down the volume on pain and shut off the alarm. Most of my clients know I’m a big fan of using imagination work to assist healing, because through imagination, we create a new physiological response and allow our lower brain to take in alarm-reducing cues. That’s what Curable’s visualizations help me do.
4. A sustainable work schedule
Making our work schedule sustainable seems to be a huge conversation in the psychology circles I’m in right now, and I’d love to share what sustainable looks like to me. First, it’s individual, and second, it changes over time.
I used to work longer hours 4 days a week. Now I’m doing fewer hours per day on a 5 days a week schedule. At different points over the years, my capacity has changed, and what works best for me to be present and engaged has changed. One of the key strategies I’m using is not filling my schedule to capacity. A full schedule for me would be 6 clients per day. But I know that this leaves zero room for inevitable parts of life and this job, including days when I’m in pain and room for urgent appointments or reports. So I only leave 5 spots open on my online calendar, and I book the 6th by my discretion. That way I can really have a look at what the day and week looks like to help me decide if it’s within my capacity or not. I also book regular time off each month and a longer period at the end of the year to fully put responsibilities away and focus on recharging.
If you too live with chronic or persistent pain: what are some of the things that help you navigate it?
Last month I had the pleasure of attending the College of Alberta Psychologist’s Annual General Meeting (AGM), where the topic was "The Psychology of Pain" (and yes, I was actually excited to attend… I’m a typical psychology nerd who loves conferences, workshops, and has a stack of partially read self-help books on my desk). I wanted to share some of the highlights for those of you who live with pain, work with people who live with pain, or both!
If you don’t fall into any of these categories, you might still appreciate this information as someone who cares about pain as a feminist issue. Increasingly, psychology is recognizing the social disparities that lead to the development and also treatment of chronic pain. The full Health Canada report also discusses pain disparities in relation to sexual orientation and gender, incarcerated populations, and veterans. It’s important to understand this disparity and what we can do to relieve the burden of the chronic pain that 1 in 4 Canadians over the age of 15 is estimated to be living with.
Injustice and our experiences of pain
The first speaker at AGM was really interesting because he discussed how feelings of injustice play a role in our experiences of pain. Specifically, he talked about a study where people who had experienced whiplash injury were asked to name the sources of their injustice. What stood out is that they identified clinicians and insurers as the perpetrators of injustice even more so than “the other driver”. This is a big deal.
When people come into our office, the last thing we want to do is add to their sense of injury. And yet, sometimes we do. Strategies used in an attempt to reassure our clients (i.e., “the pain won’t always be this bad”) can misfire and actually be experienced as invalidating. Premature focus on the positive is another misstep that can be perceived as dismissing of the client's feelings. People who have experienced difficult or unfair events are often, first and foremost, looking for validation.
I love this takeaway because it’s a reminder to all of us as clinicians or helpers: one of the biggest and most powerful things we can do to help with pain is to show up with empathy and align ourselves as an ally.
The impact of sleep on pain
Another takeaway for me was the reminder about the impact of sleep on pain. As Psychologist Melanie Noel pointed out, they’re now finding that the link between sleep and pain is not as bidirectional as people once assumed. Sleep issues drive the pain. What this means is that addressing sleep can make a huge difference in resolving symptoms of pain.
Fortunately, there’s an incredibly effective form of therapy out there called Cognitive Behaviour Therapy for Insomnia (CBT-i). I know that a recommendation for a CBT-based technique from a somatic-relational therapist may be surprising, and yet I really found it helpful for this specific issue. So, if you’re curious, it may be worth checking out. You can do so through a therapist who’s trained it in, or a resource like The Insomnia Workbook by Stephanie Silberman.
Treating sexual pain
Dr. Lauren Walker also spoke about sexual pain, an issue I too have seen in my practice. The stigma around sexual pain can mean that many people experiencing it don’t receive adequate support, nor even know that help is available.
The good news is that there are lots of professionals who can help, including physicians, pelvic floor physiotherapists, and psychologists. Of course, not all professionals are trained in the treatment of sexual pain, so you’ll want to look for someone who is, or get a referral. In Edmonton, Pine Health and Zenith Wellness are just a few of the options for physiotherapy. If you’re looking for other specialized referrals in Edmonton, don't hesitate to ask me.
Resources for chronic pain
There are so many resources on chronic pain now that you can really find a community of support. A few Instagram accounts specific to migraine that I like include Migraine Canada and Migraine World Summit.
As I’ve mentioned previously, I’ve found the Curable app’s mix of psychoeducation, meditation, and writing exercises to be incredibly helpful. You can also find them on Instagram.
At the AGM, they also highlighted the Pain Society of Alberta’s “World Pain Summit” 2021. It’s happening virtually on October 15-17 and it looks amazing. Featured keynote speakers include Dr. Kristen Neff and Dr. Gabor Mate. This event is free to those with lived experience of chronic pain (unless you’re also a healthcare provider).
If you’ve ever had your pain discounted, I hope you can start to feel heard and understood.
This is soon going to become quite obvious, but I still want to begin this post by saying that I wrote out these ideas based on my own experience of pain. They've helping me immensely in coping with what's probably been the most despairing experiences of straight up suffering I have lived through (and continue to live through). I continue to be humbled by it. So, from someone who's in it with you:
Some of you know that a few years ago, I dealt with near-daily migraines that seriously affected my capacity to work, and had a huge impact on my ability to partake in life. I had always dealt with migraines but never to this extreme, and for this long. Read on if you want to know what helped me make it to the other side.
Those of you who read my post last week know a little bit about a difficult experience I had a few years ago when I was dealing with migraines. For those of you who haven’t read it, I shared that I had been in the habit of taking on more and more until my body finally said “stop”. The chronic stress I’d been dealing with over the years, along with the acute stress of a difficult work situation, was too much for my body to handle, and it progressed to a point where I was dealing with high intensity pain on a daily basis. And that went on for a year.
Nicole Perry is a Registered Psychologist and writer with a private practice in Edmonton. Her approach is collaborative and feminist at its heart. She specializes in healing trauma, building shame resilience, and setting boundaries.
About the Blog
This space will provide information, stories, and answers to big questions about some of my favorite topics - boundaries, burnout, trauma, self compassion, and shame resilience - all from a feminist counselling perspective. It's also a space I'm exploring and refining new ideas.
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