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Mental Health

Virtual Crisis Intervention: Wave of the Future?

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Crisis intervention, once primarily delivered over the phone is increasingly being delivered through the computer and via text. Social Workers and other helping professionals need to be aware of the benefits and drawbacks of these methods of communication. Whether you work for an employer who may allow or require you to begin using these technologies or you are in private practice, learning more about text and chat for crisis intervention can enhance your practice.

Who uses text and chat?

Adults still primarily prefer to use the telephone or in-person communication to get their mental health needs met. In one large Canadian crisis service (the ONTX Project), the majority of the contacts via text message come from youth, while the majority of the computer chats come from adults.

LGBT youth – especially trans youth, may be more likely to use text and chat services because they don’t have to worry about “passing” or blending, being recognized as the gender they identify as. Via text and chat messaging there is no need to fear being mis-gendered if a client identifies as a woman but has a deep voice, for example.

How is it different from other forms of support?

Text and chat communications are slower, sometimes much slower. This means that it will take you more time to collect the same amount of information. Expect a 20 minute phone call to take closer to an hour with text and chat.

Because this method of communication is more resource intensive, you will need to carefully manage the conversation. Youth especially can talk for hours via text if they are given the option, but your therapeutic boundaries and agency policy may not permit you to engage them this long. Making an action plan to meet their immediate needs and inviting them to access the service again another time can be very helpful.

You can’t demonstrate empathy with your voice tone (obviously), so you have to be very careful to write out your empathic statements. “From what you’ve said, I really get the feeling that you felt alone.” This helps ensure that your client really feels heard.

Suicide risk assessment via text and chat

Suicide risk assessment is a more challenging task over text and chat. It’s important to make sure you firmly ask if the texter has done anything to kill themselves or end their life as soon as you determine they are suicidal. If they have, you can jump right to the active rescue procedure. You may need to adjust how you ask questions about suicide in order to fit them into 140 character limits some services have.

Accessing emergency services

This is one area that is significantly different. A lot of crisis agencies have close relationships to the police and EMS can trace phones in cases of imminent risk. On the computer though, this is a lot more difficult or even impossible. You will need to rely on your ability to build a strong rapport in order to convince your client to access active rescue.

Many texting services do not allow clients to hide their number from you, which is different from telephone services where you can block your phone number from the responding hotline worker. This can make identifying texters at imminent risk somewhat easier.

How can you build text and chat skills?

If you don’t currently have the opportunity to perform crisis intervention over text and chat through your employer, consider the ONTX Project in Canada or the Crisis Text Line in the US. These organizations allow you to volunteer to staff a web and text crisis line through the Internet, and volunteer virtually. After completing training, you’re able to volunteer between 4 and 16 hours a month for a year to help you add these valuable skills to your resume and improve your ability to serve your clients.

Will text and chat replace in-person counselling or therapy?

Some proponents of e-counselling think that text or chat will replace telephone helpline services for immediate support, but this is unlikely. Text and chat is a great introduction to helping support, but clients likely won’t be able to get all their needs met in this manner. Once they’re comfortable, you may find it more helpful to transition them to telephone or in-person support at your agency.

Dustin MacDonald is an experienced social services worker with experience in crisis intervention, data analysis and program management. He holds a Social Service Worker Diploma from Durham College and a Bachelor of Professional Arts in Human Services from Athabasca University.

          
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Mental Health

Operation Surf Uses Surfing to Help Veterans

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Photo Credit: ESPN

Every day roughly twenty veterans commit suicide. It is estimated that 22% of all suicide deaths in the US are veterans. Former professional surfer Van Curaza wants to change that.

Curaza originally founded the nonprofit Amazing Surf Adventures (ASA) as a way to help at-risk youth by getting them into the ocean and off the streets. He expanded ASA to help veterans overcome the challenges caused by war with surfing – a program dubbed Operation Surf.

Operation Surf is a free program “that offers week-long adaptive surfing trips for wounded-veteran and active-duty military men and women.” They pair veterans “with their own individual surf instructor and develop a goal-based curriculum around their unique abilities. Operation Surf offers an environment of camaraderie and healing to its participants by giving them a shared experience in the water each day.”

Curaza and Operation Surf are featured in the award-winning Netflix documentary “Resurface.” The film is about Marine Corps veteran Bobby Lane. Bobby was planning on committing suicide, but he wanted to check surfing off his bucket list first. He ended up participating in Operation Surf and it changed his life. Not only did Bobby decide he wanted to keep living, but he decided he wanted to work with Operation Surf to help other veterans.

The first time I volunteered for Operation Surf I briefly met a young man named Tommy Counihan. He was learning how to kiteboard. With his long blonde hair and slender build, he looked more like a surf hippie than a veteran.

In 2011, while on deployment in Afghanistan the armored vehicle Tommy was in drove over an IED. It exploded directly under Tommy’s feet. His right foot ended up needing to be amputated. But it was more than a physical injury, “I felt like when I made that decision that day to amputate my foot that I lost more than just a physical part of myself,” he said. “It plays tricks on your head. It brings you to a really dark place that’s almost impossible to get out of on your own. I remember the times when I would sit there by myself and contemplate whether or not I should commit suicide.”

On the advice of his therapist, Tommy participated in Operation Surf. Even though Tommy had surfed when he was a teenager, he was skeptical that it would help him now. Then he caught his first wave, “I was just so ecstatic that I was able to stand up on that board because in that one instant I knew that everything that I thought I had lost was just something I was creating in my head. That I was going to be able to do it all. I just had to push myself to overcome these barriers that I placed in front of myself.” Tommy won the wounded warriors division at the Hawaii Adaptive Surfing Championship last year.

Surfing can have a profound impact on veterans’ mental health. Dr. Russell Crawford, Air Force veteran and licensed therapist, conducted a research study on Operation Surf participants and found that surfing decreased PTSD symptoms by 36%, decreased depression by 47%, and increased self-efficacy by 68%.

Surfing can help veterans overcome the challenges caused by war. It has given Bobby, Tommy, and hundreds of other veterans a new lease on life. You can show your support by volunteering or donating to Amazing Surf Adventures and Operation Surf by visiting their website.

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Health

How to Maintain Mental Health When Diagnosed with a Physical Illness

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A diagnosis of a physical disease or ailment is the last thing anyone wants to encounter in their lifetime. Humans are naturally concerned with self-preservation, which prompts our hunger for advancements in comfort, technology, and healthcare. For many people, a cancer diagnosis may be the worst news they receive, but imagine having multiple diseases piling on top of each other and feeding off one another.

Here lies the intersection between mental and physical health. A study published in the Western Journal of Medicine (WJM) by psychiatrists Jane Turner and Brian Kelly found these ailments can compound one another, leading to the worsening of both illnesses.

Mental and Physical Health, Linked

It is no surprise a diagnosis with a chronic physical illness can lead to feelings of grief, sadness, hopelessness, and a general need to adjust to a new lifestyle. However, the WJM study found sometimes these feelings can turn into something more severe, like depression or other psychiatric disorders.

Separating an expected period of emotional adjustment from a legitimate disorder is difficult, as is discerning between symptoms associated with depression, or ones common in patients of physical diseases.

For example, cancer patients undergoing strenuous and tiresome treatments like radiation or chemotherapy are likely to experience fatigue, appetite changes, weight fluctuations, mood disturbances, and sleep pattern changes. These symptoms are also common in depression patients, which can make a mental diagnosis very difficult.

“Despite these difficulties,” wrote Turner and Kelly, “it is essential to diagnose and treat depression in patients with chronic conditions. Even mild depression may reduce a person’s motivation to gain access to medical care and to follow treatment plans.”

If patients begin to neglect their treatments, this may impact their physical health, leading to further feelings of hopelessness and an exacerbation of depressive states, creating a vicious cycle hurting the patient at the center of it all.

Those Who Are Hit Hardest

Certain populations are more at risk of developing serious diseases than others. Cancers often result in this sort of psychological impairment, and there are a number of risk factors for developing different forms of the disease.

Low-income populations are generally more at risk for developing cancer, as evidenced by a Korean study found the lowest income brackets are over 110% more likely to develop stomach, lung, liver, rectal and cervical cancers.

Lung cancers, in particular, have a much higher incidence among lower income tiers at around 160% more likely. Developing cancers like mesothelioma or lung cancer can be largely due to environmental factors, which can be difficult to rectify for lower-income populations.

Asbestos, the only known cause of mesothelioma, was used amply in the construction of housing complexes during the 20th century. Many low incomes and public housing complexes have been around since the asbestos era, disproportionately exposing people who live there to the dangers of asbestos.

Other environmental toxins like smoke, lead paint, mold, and chemicals are common in housing complexes and are all risk factors for cancers and other health ailments.

For social workers, it’s important to make sure residents of places with environmental toxins are aware of their available courses of action. For example, if a building built before 1980 appears to be in disrepair, residents can approach their landlords about bringing in asbestos abatement professionals. Many states have provisions concerning the habitability standard property owners must maintain, or risk having their tenants break their leases.

Treating the Mind and Body

For anyone diagnosed with a serious physical illness, mental health care should be part of a holistic treatment plan. Mary Jane Massie, a psychiatrist specializing in treatment for people with breast cancer at the Memorial Sloan Kettering Cancer Center, has learned oncology patients do less well when depressed.

“This is probably due in part to the fact that because they feel bad,” Massie said. “Psychologically, physically, or both —they decide it isn’t useful to take their medications. And there can be a domino effect: They stop filling their prescriptions and may even start to miss medical appointments. But there is a lot of help available.”

Many top notch cancer treatment centers like Memorial Sloan Kettering now offer emotional support services, but not everyone can afford these facilities or is geographically close to them. Of course, there are other ways to help these patients.

Many diseases, like Alzheimer’s, Breast Cancer, and ALS, have extensive support networks for patients and their families. Support groups for physical diseases can help mental health by connecting people going through similar circumstances and giving them an outlet to talk.

Other emotional support options include individual counseling, online support groups, and virtual therapists. Some patients may prefer to go the route of medication. Depending on the individual, talk therapy may feel like too much of a commitment and antidepressant medications may seem undesirable for other reasons.

Psychological concerns don’t end after the physical disease has been treated though. Post-treatment depression can be common for many patients, even those who didn’t suffer mental health concerns during diagnosis or treatment. For other patients, end of life counseling may be in order.

Healthcare professionals are generally equipped to treat the whole patient, but some people may not know when to ask for additional help beyond physical treatment. For a patient of any serious illness, it’s important to recognize the symptoms of psychological distress and familiarize themselves with what to expect along the treatment path.

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Education

What is Social Emotional Learning?

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The Collaborative for Academic, Social, and Emotional Learning (CASEL) defines social and emotional learning (SEL) as “The process through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.”

Within the context of schools, SEL can be easily understood as the study of soft skills. SEL is where students learn how to treat others and how to treat themselves in a responsible, caring, and compassionate way.

Why do Social Workers Work as SEL Coordinators?

Oftentimes, schools rely heavily on teachers to provide SEL instruction and planning. While many teachers deeply value SEL learning, sometimes the pressure for students to perform well academically leads teachers to prioritize content lessons over life skills. When schools hire a specific person to coordinate and teach SEL, it sets aside time specifically for SEL and creates accountability for SEL practices within the school. Social workers are the right person for this job for a variety of reasons.

Firstly, social workers are highly qualified to teach the content. The core values of social work align perfectly with the learning goals of SEL. The social work profession is grounded in the values of social justice, the importance of human relationships, competence, integrity, service, and the dignity and worth of the person.

These values are aligned with the five competencies of social and emotional learning: self-awareness, social awareness, responsible decision making, relationship skills, and self-management. For instance, social workers value relationships and learn explicitly in school how to develop authentic relationships with clients. Therefore, social workers are equipped to break down and model what it looks like to have relationship skills. Further, CASEL teaches that effective SEL programming is SAFE: sequenced, active, focused, and explicit.

Social workers have training in explicitly teaching social skills through explicit and focused role-plays. This skill can be easily modified and applied to the whole-class setting, seamlessly integrating social work therapeutic techniques with direct instruction. Additionally, social workers know how to respond in the moment. Due to the reflective and process-oriented nature of SEL lessons, students may sometimes disclose personal information, such as experiencing abuse, death in the family, thoughts of suicide, bullying, and more.

Not only do school social workers know the correct protocols for handling high-risk situations, such as suicide ideation or abuse, but social workers can provide therapeutic services in the school or refer students to effective mental health providers in the community. Social workers have training in both responding in the moment with empathy and also caring for themselves as practitioners later through explicit self-care to prevent burn-out. Teachers may not always feel comfortable and prepared to respond to difficult disclosures such as these.

Benefits to the Mental Health Staff

The social worker providing direct SEL instruction builds a reciprocal nature, benefiting all mental health staff at the school. With effective SEL services, the number of students needing more intensive services may decrease as students learn adaptive coping skills, healthy relationships, and effective conflict resolution within the classroom setting. When students are equipped with these proactive skills for addressing common problems which emerge in school, maladaptive responses that require the assistance of mental health professionals become less common.

Further, students who do need additional social work services benefit from a renewed sense of anonymity and decreased shame. When all students in the school are accustomed to interacting weekly with the school social worker, it becomes less obvious which students are receiving intensive services. Young students do not assume when a social worker walks into a classroom they are there for one specific student and therefore, privacy is restored.

Additionally, by offering ways for all students to see the social worker through self-referrals and lunch bunch services, almost all students trickle in and out of the social work office at one point or another. With this volume of foot traffic, students are much less likely to be concerned a peer may notice them coming or going from the office. Talking to the social worker about problems and issues becomes the norm, effectively alleviating mental health stigmas which often permeate through schools and the larger community.

Lastly, when the social worker takes such an active role in the classroom setting, they are better equipped to effectively respond to students with high needs when crises happen. Oftentimes in large school settings, student to social worker ratios can be extremely high. This presents challenges to building authentic relationships with all students at the school as social workers may be meeting students for the first time during a crisis. When the social worker provides direct SEL instruction, it is almost guaranteed the student and social worker have interacted positively during class previous to the incident. A level of trust is built faster and with more authenticity during the most difficult situations.

How the SEL Coordinator Position Works

Social workers are ideal providers of SEL instruction and support in schools. The social work mission requires practitioners to enhance well-being and empower those who are most vulnerable (NASW, 2008). By supporting students with SEL development in school, social workers equip students with valuable life skills that not only enhance their well-being, but may in the long-term serve as a protective factor for many inequitable outcomes.

Presently, I work in partnership with our school counselor in a school of approximately 600 students pre-kindergarten through fifth grade to provide wellness services. Our school counselor provides tier two and three services while I primarily provide tier one and two. This arrangement allows me to be available for predictable and scheduled classes in a way school social workers are typically not, as I am not pulled out for crisis response. I provide SEL lessons through direct instruction in all 19 of our elementary homerooms bi-weekly.

On the weeks I do not provide direct instruction, I prepare lesson plans and materials for homeroom teachers to implement the lessons on their own. To support the SEL curriculum, I also provide ongoing training to staff and family roundtables for parents/guardians. Additionally, I provide social skills and therapeutic services for students through individual and group services outside of regularly scheduled lessons.

All students are given the opportunity to meet with me through lunch bunches, where students sign up to eat lunch in my office. Through self-referral services, students request to discuss mental health-related concerns with a member of the wellness team. Overall, my week is split halfway between direct instruction in the classroom and more typical school social work services.

Closing Thoughts

When I enter the school building, I hear echoes of “Good morning Ms. Knipp!” as I make my way to my office. One elementary student holds up two fingers when he sees me, to indicate he has put two drops in classmate’s buckets (our way of measuring kind acts) so far this week. When I arrive at my office and open my calendar, I see today I have four lessons, a lunch session, two therapeutic groups, and a parent learning event after school.

I have the best job in the world. I am a social worker, but my official job title is “Social and Emotional Learning Coordinator.” My main responsibility is proactive, preventive work through direct instruction of social and emotional learning.

Empowering students with tools for SEL development at a young age promotes social justice in the long run. Social workers have the training and values necessary to implement these lessons in schools now. SEL instruction implemented by social workers not only improves the school, but it also improves social work practices within educational environments.

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Mental Health

Study Highlights Racism, Sexual Assault as Contributors to College Mental Health Challenges

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A text mining analysis of academic and news articles related to mental health issues in higher education finds that racism, violence and sexual assault are key contributors to mental health challenges for students. The research also highlights the need for mental health services, and outlines some ways that mobile technologies may be able to help address these needs.

“We had found in our previous work that students are concerned about mental health issues, and we wanted to better define the scope of mental health challenges for students and what factors contribute to those challenges,” says Fay Cobb Payton, corresponding author of a paper on the work and a professor of information systems/technology and University Faculty Scholar at North Carolina State University.

To address these questions, the researchers used text mining techniques to analyze 165 articles published between 2010 and 2015. The researchers drew on both peer-reviewed research literature and articles published in higher-education news outlets.

“We included news outlets because that allowed us to capture timely information that reflected conditions across campuses nationally,” Payton says.

The most common theme that cropped up in the articles was an increased need for student mental health services, an idea that appeared in 68 percent of the analyzed material. Among factors that contribute to mental health concerns, the most common was racism and bias against ethnic groups, found in 18 percent of the articles. The researchers also pointed to violence and sexual assault – mentioned in 5 percent of the articles – as a significant contributing factor.

The researchers note that colleges and universities are taking steps to both provide mental health services and offer targeted outreach to students of color. But, the researchers say, many students are simply not taking advantage of the services that are available.

“More needs to be done to address the stigma associated with seeking help in the aftermath of violence or sexual assault, and more needs to be done to address the stigma associated with seeking help for mental health challenges,” says Lynette Kvasny Yarger, co-author of the paper and an associate professor of information sciences and technology at Pennsylvania State University.

“Students who are facing the trauma of sexual assault are dealing with the dual stigma of seeking help for both the assault and the ensuing mental health challenges,” Payton says.

The researchers also note that mobile technologies may help to meet some of these mental health needs.

“Mobile apps may be valuable for sharing information and resources with students, as well as providing students with improved access to treatment or to connect with communities that could offer peer support,” Payton says. “Apps could also be used to create opportunities for peer training or for storytelling that could address issues related to stigma.”

However, the researchers note, such mobile app interventions should be driven by evidence-based approaches – and the field of mobile interventions is still in its relatively early stages.

“Our study highlights salient mental health issues for researchers seeking to develop impactful mobile interventions,” Payton says. “Additional evidence-based research is needed in this domain.”

The paper, “Text Mining Mental Health Reports for Issues Impacting Today’s College Students: Qualitative Study,” is published in the journal JMIR Mental Health. The paper was co-authored by Anthony Pinter of the University of Colorado Boulder.

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Mental Health

Self-Regulation Significant to Overcoming Early Adversity in Drug and Alcohol Abuse

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Self-regulation may hold the key to helping young adults overcome their risk for developing alcohol and drug problems, according to recent research from the University of Georgia.

The study looked at 225 non-college-educated adults aged 18-25 from lower socioeconomic backgrounds who grew up in rural areas in Northeast Georgia. Led by Assaf Oshri, an associate professor in the UGA College of Family and Consumer Sciences, the research team found that young adults who experience abuse as children have a higher risk for developing alcohol and drug problems. These same young adults also have a decreased ability to self-regulate, or avoid impulsive decision-making in socially stressful situations.

Oshri pointed to the results as evidence of the need for family-focused preventive intervention programs for adolescents that target self-regulation, in hopes of better identifying factors that promote resilience among youth.

“If we use delayed gratification, we can do well in life, but it seems like those who have specific early life experiences are less able to perform this optimal decision-making, and that can affect their risk of substance abuse,” said Oshri, who is housed in the department of human development and family science.

Protective factors at the biological and psychosocial levels offer hope that interventions targeting decision-making can help at-risk youth, he explained.

“The goal is to try to identify mechanisms that will help youth who experience adversity in life,” he said

During the study, the young adults were assessed twice over two years. In addition to completing surveys measuring their drug and alcohol use and experiences with child maltreatment, participants completed a decision-making task that evaluated their tendency to make impulsive decisions and ability to self-regulate and delay gratification.

To accomplish this, researchers used a tool called “delayed reward discounting.” The young adults answered questions such as “Would you rather have $14 today or $25 in 19 days?” They also agreed to have their heart rates measured while they completed a series of increasingly difficult math-related tasks in front of an audience of research assistants. These measurements allowed researchers to record stress levels and assess self-regulatory capacities.

Study results found that as participants’ maltreatment experiences as children increased, the higher their inclination toward impulsive decision-making and problems delaying gratification.

The paper, “Child maltreatment, delayed reward discounting and alcohol and other drug use problems: The moderating role of heart rate variability,” was published online in August in the journal Alcoholism: Clinical and Experimental Research.

Co-authors are UGA graduate students Sihong Liu and Erinn Bernstein Duprey and James MacKillop from McMaster University in Canada. The work was supported by the UGA Owens Institute for Behavioral Research and the Sarah H. Moss Fellowship for UGA faculty.

The abstract can be found at https://onlinelibrary.wiley.com/doi/full/10.1111/acer.13858.

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Mental Health

Get Comfortable With Not Knowing

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How easy is it for you to be in a state of not knowing? Not knowing what will happen next? Not knowing your next step? Not knowing who you are as you’ve evolved into this present moment?

Not knowing can be an unsettling prospect. We like to know. We like to think that we know.

It is much more comfortable to feel like we have it all figured out ~ like we are guaranteed the outcome of our desires. And most of the time, we do feel like we are in the know when it comes to what our day will bring and what we can expect from each other.

The truth is though, that things can change on a dime. We find a sense of security with the thought that we can expect things to move along as they always have. Of course, we feel more secure when that expected direction is something that we want.

Alternatively, when we find ourselves stuck in situations that challenge us, we might pray for things to change while harbouring a suspicion that they never will because we know how these things have always played out in our lives before.

What if we got really cozy with the very real state of not knowing? What if we made friends with the reality that we could be surprised at any moment? And what if we began to anticipate that these surprises could be enriching and life-affirming as opposed to dark and threatening?

Serving Consciously

Recently on Serving Consciously, I interviewed Alexander Demetrius who has immersed himself in the vast expanse of the unknown and has discovered the rewards inherent in it.

Alexander Demetrius

Alexander Demetrius’ literary contributions have primarily been influenced by Joseph Campbell. During his lifetime, Campbell was one of the world’s foremost authorities on global mythology. Using Campbell’s monomyth or hero’s journey, Demetrius discovered that critical events from his past paralleled the typical sequence of events found in practically every narrative throughout the world.

The Reward of Not Knowing is an account of Demetrius’ memoirs, transformed into an epic journey that began in San Antonio, Texas, and spans across the Pacific Ocean to Honolulu, Hawaii, where he currently resides. What makes his journey unique is that much of it took place within, where so few ever voyage.

Through careful reflection and examination, he overcame some paralyzing characteristics that once constrained him to a life of insanity, orchestrated by his mother who suffers from dissociative identity disorder or multiple personalities.

Tap into All that You Do Know

It is easier said than done ~ this idea of being comfortable not knowing. Sure, we can acknowledge that we are lacking information in the moment or that we can’t see the next step on the path, but feeling comfortable with it? That’s another story.

To assist ourselves in this process, we can shift our focus to what we do know for sure.

Do you know that you can trust yourself?

Do you know that you can have faith in the process?

Do you know that you are capable of getting back up EVERY time you fall down?

Do you know that you are loved?

How connected are you to your resiliency?

How connected are you to your capacity to care for yourself?

How connected are you to your internal guidance system ~ your intuition?

How connected are you to a sense of self-love and self-worth?

If things go wrong, do you know that you can course correct?

If you feel unsupported, do you know you have your own back?

If you are frightened by what’s around the next corner, do you know that you can face whatever comes?

If you can’t see the forest for the trees, do you know that clarity resides within you and will eventually emerge?

Tune into all that you know to be true regardless of any evidence. Allow the unknown to exist without pressure from you to be different. Be patient as new information becomes available.

Learn to dance with the mystery.

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