Sites with Free Therapy Worksheets & Handouts

(Updated 5/4/20) A list of sites with free printable resources for mental health clinicians and consumers

By Cassie Jewell, M.Ed., LPC, LSATP

If you’re a counselor or therapist, you’re probably familiar with Therapist Aid, one of the most well-known sites providing free printable worksheets. PsychPoint and Get Self Help UK are also great resources for cost-free handouts, tools, etc. that can be used with clients or for self-help.

When I started blogging, I realized just how much the Internet has to offer when it comes to FREE! That being said, I’ve learned the term free is often misleading. There are gimmicky sites that require you to join an email list in order to receive a free e-book, PDF printables, etc.; I don’t consider that free since you’re making an exchange. I also dislike and generally avoid sites that bombard with ads. A third “free-resource” site that’s deceiving is the site with no gimmicks or ads, but turns out to be nothing more than a ploy to get you to buy something.

For this post, I avoided misleading sites and instead focused on government agencies, educational institutions, and nonprofits. I found some sites that offered a variety of broad-topic PDF resources and others that had fewer, but provided specialized tools. See below for links to over 50 sites with free therapy worksheets and handouts for both clinicians and consumers.

(Click here for free worksheets, handouts, and guides posted on this site.)

Please check back frequently; I update regularly.

Mental Health & Addiction (Sites with Worksheets/Handouts on a Variety of Topics)

91 Free Counseling Handouts | Handouts on self-esteem, emotions, recovery, stress, and more

A Change in Thinking: Self-Help Library | A large collection of worksheets and handouts on communication, relationships, depression, and more

A Good Way to Think: Resources | Worksheets and handouts on happiness, well-being, values, etc.

Articles by Dr. Paul David | Clinical handouts on depression, relationships, substance use disorders, family issues, etc.

ASI-MV Worksheets & Handouts | Addiction and recovery handouts

Belmont Wellness: Psychoeducational Handouts, Quizzes, and Group Activities | Printable handouts on assertiveness, emotional wellness, stress management, and more

Black Dog Institute: Clinical Resources | Download fact sheets, handouts, mood trackers, and more on a variety of mental health topics

Brene Brown: Downloads and Guides | Resources for work, parenting, the classroom, and daily life

Bryan Konik | Therapist & Social Worker: Free Therapy Worksheets | A collection of worksheets on stress management, anxiety, relationships, goal setting, and trauma

Cairn Center: Resources | A modest collection of printable assessments, handouts, and worksheets on DBT, anxiety, depression, etc.

Client Worksheets from Treatment for Stimulant Use Disorders (Treatment Improvement Protocols Services) | 44 client worksheets on addiction and recovery

Cornell Health: Fact Sheet Library | A variety of handouts and tracking sheet on various health topics; only a few relate to mental health and addiction

Daniel J. Fox, Ph.D.: Forms, Presentation Slides, and Worksheets | Topics include anger, emotions, borderline personality disorder, etc.

DOWNLOADS from Get Self Help | Free therapy worksheets and handouts on a variety of topics

Dr. Danny Gagnon, Ph.D., Montreal Psychologist: Self-Help Toolkits | Articles and handouts on worry, depression, assertiveness, etc.

EchoHawk Counseling: Materials and Resources | Articles, worksheets, and handouts on a variety of topics (boundaries, emotions, grief, stress, trauma, etc.)

Eddin’s Counseling Group: Worksheets | A short list of free worksheets and handouts

Faith Harper: Worksheets and Printables | A small collection of therapy worksheets and handouts, including a gratitude journal

Forward Ethos: Guide Sheets | Worksheets on mindfulness, anxiety, self-care, intimacy, relationships, and more

Free Stuff for Consumers and Professionals | A short list of downloads (Source: Jonathan S. Abramowitz, Ph.D.)

InFocus Resources | Family handouts on addiction

Lynn Martin | A short list of client handouts, including questionnaires

Mark R. Young, LMSW, LCSW (Resolving Concerns): Links & Forms | Links to factsheets, worksheets, assessments, etc.

Mental Health CE | Course content handouts on a variety of mental health topics

Motivational Interviewing Worksheets

My Group Guide: A Collection of Therapy Resources

Oxford Clinical Psychology: Forms and Worksheets | A large collection of therapy worksheets based on evidence-based practices

Peggy L. Ferguson, Ph.D.: Addiction Recovery Worksheets | A modest collection of handouts/worksheets for addiction and recovery

PsychPoint: Therapy Worksheets

Self-Help Exercises from Gambling Therapy

Self-Help Reading Materials | Links to handouts on self-help topics (Source: Truman State University)

Self-Help Tools from Mental Health America | Links to assessments, worksheets, handouts, and more

Sleep and Depression Laboratory: Resources | A small collection of worksheets related to sleep, worry, and depression

SMART Recovery Toolbox | Addiction and recovery resources

The Stages of Change | A 7-page PDF packet (Source: Virginia Tech Continuing and Professional Education)

Step Preparation Worksheets | (Source: treatmentguide4u.com)

Substance Abuse | A 13-page PDF packet

Taking The Escalator: Therapy Tools | Handouts on addiction and recovery

Therapist Aid | Free therapy worksheets

Therapy Worksheets | A therapy blog with links to free worksheets on various mental health topics

Tools for Coping Series | A large collection of handouts on coping skills

Worksheets from A Recovery Story (Blog) | A small collection of addiction and recovery worksheets

Depression, Stress, & Anxiety

Alphabet of Stress Management and Coping Skills | Coping skills for every letter of the alphabet

Anxiety 101 | An 11-page PDF packet (Source: Michigan Medicine | University of Michigan)

Anxiety Canada: Free Downloadable PDF Resources | Anxiety worksheets for parents and self-help

Behavioral Activation for Depression | A 35-page packet

Coping with Anxiety and Panic Attacks: Some Cognitive Behavioural Self-Help Strategies | A 10-page packet

Creating Your Personal Stress Management Plan | A 10-page packet

Dr. Chloe: Worksheets for Anxiety Management | A small collection of worksheets and handouts

Panic Attack Worksheets (Inner Health Studio) | A 9-page PDF packet

Relaxation | A 15-page packet on relaxation skills for anxiety

Stress Management (Inner Health Studio) | A 5-page packet on stress management

UMASS Medical School Department of Psychiatry: Stress Management – Patient Handouts | A collection of handouts on stress management. Some of the other sections, including “General Health and Wellness” and “Nutrition” have links to handouts as well

Trauma & Related Disorders

Center for Sexual Assault & Traumatic Stress: Therapist Resources | More than just worksheets: client handouts, assessments, info sheets, toolkits, training resources, links, etc.

Child and Family Studies: Sex in the Family | An 8-page packet on shame and guilt in relation to child sexual abuse

Common Reactions to Trauma | A 1-page PDF handout

Detaching From Emotional Pain (Grounding) | A 12-page PDF packet (Source: Sunspire Health)

Grounding Exercises | A 2-page PDF handout

Grounding Techniques | A 1-page PDF handout from JMU Counseling Center

Grounding Techniques | A 2-page PDF handout

Healing Private Wounds Booklets | Religious handouts on healing from sexual abuse

Seeking Safety Resources | Printable worksheets on PTSD, substance abuse, and healthy relationships

Selected Handouts and Worksheets from: Mueser, K. T., Rosenberg, S. D., & Rosenberg, H. J. (2009). Treatment of Postraumatic Stress Disorder in Special Populations: A Cognitive Restructuring Program | A 13-page PDF packet

Trauma Research and Treatment: Trauma Toolkit A small collection of trauma handouts

Traumatic Stress: The Effects of Overwhelming Experience on the Mind and Body | A 12-page PDF packet (Source: Dan Metevier, Psy.D., Clinical Psychologist)

Wisconsin Hawthorn Project: Handouts & Worksheets | Handouts in English and Spanish

Psychosis

CBT for Psychosis & Trauma Handouts

Early Psychosis Intervention: Client Worksheets | Scroll down to the “Client Worksheets” section for links. Use with clients who are experiencing psychosis

Goal-Setting Worksheet for Patients with Schizophrenia | A 3-page PDF

List of 60 Coping Strategies for Hallucinations | A 2-page PDF

Treatment for Schizophrenia Worksheet Pack | A 6-page PDF packet

ACT, CBT, & DBT

ACT Mindfully: Worksheets, Book Chapters & ACT Made Simple | ACT worksheets and other free resources

Cognitive Therapy Skills | A 33-page packet

Carolina Integrative Psychotherapy | A small collection of DBT worksheets and handouts

Clinician Worksheets and Handouts: Clinician Treatment Tools | A variety of CBT, DBT, etc. therapy worksheets

CPT Web Resources | A short list of worksheets and handouts

DBT Peer Connections: DBT Handouts and Worksheets | DBT resources

DBT Self-Help | Printable lessons and diary cards

Dr. John Forsyth: Free Resources | Download two free packets of worksheets (ACT and mindfulness)

Living CBT: Free Self-Help | 20+ CBT worksheets

Lozier & Associates: Dialectical Behavior Therapy Printables – DBT Worksheets and DBT Handouts | A small collection of DBT handouts and worksheets

Printable Versions of CPT/CBT Worksheets | English and Spanish worksheets (Source: The F.A.S.T. Lab at Stanford Medicine)

Veronica Walsh’s CBT Blog: Free Downloadable Cognitive Behavioural Therapy Worksheets/Handouts | Print/use these worksheets only with blog author’s permission

Grief & Loss

Activities for Grieving Children | A 7-page PDF

Bereavement Handouts (Hospice & Palliative Care) | A small collection of handouts

The Center for Complicated Grief: Handouts | Assessments, handouts, and guides

A Child’s Understanding of Death | An 11-page packet

Handouts to Download and Print: One Legacy | Handouts on grief and loss

Loss and Grief Handouts

Loss, Grief, and Bereavement | A 35-page PDF packet

Grief Factsheets: My Grief Assist

Printable Grief and Loss Resources | A fairly extensive collection of printable handouts on grief and loss

Anger

Anger Inventory | A 7-page PDF packet

Anger Management | A 13-page PDF packet

Anger Management Techniques | A 4-page PDF

Dealing with Anger (Inner Health Studio) | A 7-page PDF packet

Free Anger Management Worksheets: Letting Go of Anger | A small collection of worksheets for anger management

Getting to Know Your Anger | A 42-page PDF packet

Love To Know: Free Anger Worksheets | 7 downloadable anger management worksheets

Steps for Change: Anger Management Worksheets

Self-Esteem

Confidence Activities | A 25-page PDF packet

Free Self-Esteem Worksheets

Growing Self-Esteem: Self-Esteem Worksheets

Improving Self-Esteem: Healthy Self-Esteem | A 10-page PDF packet

Self-Esteem Activities | A modest collection of handouts/activities for self-esteem

Self-Esteem Experts: Self-Esteem Activities | Printable handouts on self-esteem

Self-Esteem Printable Worksheets

Spiritual Self-Schema Development Worksheets: Yale School of Medicine

Values & Goal-Setting

10 Free Printable Goal-Setting Worksheets (from Parade)

Core Values and Essential Intentions Worksheet | A 2-page PDF worksheet

Core Values Clarification Exercise | A 4-page PDF worksheet

Core Values Worksheet | A 4-page PDF worksheet

Life Values Inventory | A 5-page printable PDF (Source: Brown, Duane and R. Kelly Crace, (1996). Publisher: Life Values Resources, pinnowedna@charter.net)

Personal Values Card Sort | A 9-page printable PDF (Source: W.R. Miller, J. C’de Baca, and D.B.Matthews, P.L., Wilbourne, University of New Mexico, 2001)

Values | A 2-page PDF worksheet

Values and Goals Worksheet | A 1-page PDF worksheet

Values Assessment Worksheet | A 2-page PDF worksheet

Values Exercise | A 2-page PDF worksheet

Values Identification Worksheet | A 6-page PDF worksheet (Source: Synergy Institute Online)

Values Inventory Worksheet | A 2-page PDF worksheet

What Are My Values? | A 4-page PDF worksheet from stephaniefrank.com

Children & Youth

A Child’s Understanding of Death | An 11-page packet

A Collection of Anger Management/Impulse Control Activities & Lesson Plans (PreK-3rd Grade) | A 64-page PDF packet

Activities for Grieving Children | A 7-page PDF

Cope-Cake: Coping Skills Worksheets and Game | A 30-page packet for young children/students

Crossroads Counseling Center: Resources | Handouts on depression, anxiety, ADHD, etc. in children

Curriculum Materials from Pennsylvania Child Welfare Resource Center | Links to handouts

The Helpful Counselor: 10 Awesome Behavior Management Resources | Worksheets to use with children

Myle Marks: Free Downloads | Worksheets for children

Prevention Dimensions: Lesson Plans | Downloadable PDF handouts for children from kindergarten to sixth grade (Source: Utah Education Network)

Printable Worksheets | Worksheets for children on physical activity, substance abuse, nutrition, and more (Source: BJC School Outreach and Youth Development)

Social Emotional Activities Workbook | A 74-page PDF packet

Social Skills Worksheets | A packet of worksheets to use with children/youth

Stress Reduction Activities for Students | Link to a 20-page packet (PDF)

Adolescents & Young Adults

Change To Chill | Worksheets and handouts for reducing stress in teens and young adults

Emotional Intelligence Activities for Teens Ages 13-18 | A 34-page PDF packet

Handouts: Eppler-Wolff Counseling Center (Union College) | Handouts for college students

Healthy Living (Concordia University) | Handouts and articles for college students

Just for Teens: A Personal Plan for Managing Stress | A 7-page PDF handout

Oregon State University: Learning Corner | Student worksheets on time management, wellness, organization skills, etc.

The Relaxation Room (Andrews University) | Self-care and stress management handouts for college students

Resilience Toolkit from Winona State University | PDF handouts for college students on resiliency

Self-Help Resources from Metropolitan Community College Counseling Services | Links to articles for college students on a variety of topics (not in PDF form)

Self-Help (Western Carolina University) | Handouts for college students

Step UP! Program Worksheets and Handouts | Worksheets/handouts for students on prosocial behavior and bystander intervention

Teens Finding Hope: Worksheets and Information to Download | Spanish and English PDFs available

Tip Sheets from Meredith College Counseling Center | Student tip sheets on anger, body image, relationships, and other topics

Tools & Checklists from Campus Mind Works | Handouts and worksheets for students

UC Berkeley University Health Services Resources | Links to handouts, articles, and self-help tools for students

UMatter | Tools for college students on wellness, communication, healthy relationships, and more (Source: Princeton University)

Western Carolina University Counseling and Psychological Services: Self-Help | A modest collection of student wellness handouts along with a printable self-help workbook

Your Life Your Voice (from Boys Town): Tips and Tools | Links to articles and PDF printables on a variety of topics for teens and young adults

Marriage/Relationships & Family

21 Couples Therapy Worksheets, Techniques, & Activities | From Positive Psychology

Articles for Parenting from MomMD | Links to various articles/handouts (not in PDF form)

Drawing Effective Personal Boundaries | A 2-page PDF handout (Source: liveandworkonpurpose.com)

Emotionally Focused Therapy: Forms for Couples | A list of forms to use in EFT couples counseling

Exercises for Forgiveness | A 7-page PDF for recovering from an emotional affair

Healthy Boundaries by Larry L. Winckles | A 3-page PDF handout

Healthy Boundaries Program | A 15-page PDF packet (Source: The University of Toledo Police Department)

Healthy Boundaries vs. Unhealthy Boundaries | A 6-page PDF handout (Source: kimsaeed.com)

Hope Couple: Counseling Resources | Assessments and worksheets from a Christian counseling site

Joy2MeU | A collection of articles by Robert Burney on relationships, codependency, and related topics (not in PDF form)

New Beginnings Family Counseling: Handouts | Click on “Resources” to view and download handouts on relationships, anxiety, and depression. You can also download relationship assessment tools

Pasadena Marriage Counseling: Free Marriage Counseling Resources | A small collection of worksheets for couples therapy

Relationship Counseling Forms | PDF forms for couples therapy (Source: Dan Metevier, Psy.D., Clinical Psychologist)

Signs of Unhealthy Boundaries | A 6-page PDF handout (Source: Healing Private Wounds)

Additional Worksheets & Handouts

8 Helpful “Letting Go of Resentment” Worksheets | Links to PDF worksheets

90-Day Health Challenge | Several health worksheets for download (Source: HealthyCampbell)

Acorns to Oaktrees: Eating Disorder Worksheets/Eating Disorder Forms | A small collection of handouts for eating disorders

Activity eBooks from Rec Therapy Today | A collection of downloadable workbooks on self-esteem, social skills, emotions, etc.

Alzheimer’s Association: Downloadable Resources | Handouts on Alzheimer’s

Attitudes and Behaviour | A 9-page PDF packet on criminal thinking

Commonly Prescribed Psychotropic Medications | A-page PDF (Source: NAMI Minnesota)

Conflict Resolution Skills | A 6-page PDF packet

Coping Skills | A 2-page PDF worksheet (Source: Temple University)

EDA Step Worksheets | From Eating Disorders Anonymous

Experiential Group Exercises for Shame-Resilience | A 4-page PDF packet with questions for discussion and group activities

Free Mindfulness Worksheets (Mindfulness Exercises) | A large collection of mindfulness handouts

Go Your Own Way | Downloads for veterans on various topics

Guilt vs. Shame Infographic: National Institute for the Clinical Application of Behavioral Medicine | Printable infographic to illustrate the differences

Handouts and Worksheets | A 21-page PDF packet with handouts and worksheets on selfe-care topics

Homework and Handouts for Clients: ACT With Compassion | Handouts and worksheets related to self-compassion

Integrated Health and Mental Health Care Tools | Downloadable resources from UIC Center

International OCD Foundation: Assessments & Worksheets | Handouts for use with individuals with OCD

Learning to Forgive: The 5 Steps to Forgiveness | A 6-page PDF handout from Thriveworks

Managing Emotional Intelligence | A 7-page PDF packet (Source: inclusiv.org)

Motivation To Change | A 16-page PDF packet on motivation to change criminal behavior

Peers & Relationships | A 12-page PDF packet on how associates impact criminal behavior

Personal Development: Workplace Strategies for Mental Health | Handouts on resilience, communication, etc.

Prochaska and DiClemente’s Stages of Change Model | A 4-page PDF handout

Quick Reference to Psychotropic Medication | Downloadable PDF chart from John Preston, Psy.D.

Radical Forgiveness: Free Tools | A small collection of worksheets on forgiveness

Reducing Self-Harm | A 5-page PDF

Self-Care and Wellness Resources | Printable handouts and tools (Source: irenegreene.com)

Self-Care Starter Kit from University at Buffalo School of Social Work | Handouts on self-care topics

Self-Directed Recovery | Downloadable resources from UIC Center

Shame Psychoeducation Handout | A 5-page PDF handout

Stages of Change: Primary Tasks | A 2-page PDF handout

Therapy Worksheets: ADHD ReWired | Thought records, behavior charts, and other tools

Understanding and Coping with Guilt and Shame | A 4-page PDF handout

Wellness Toolkits | Printable toolkits from NIH


Please contact me if a link is no longer valid or if you’d like to recommend a site!

Marriage & Relationship Assessment Tools

Free screening tools for assessing relationship satisfaction/expectations, attachment styles, communication, domestic violence/sex addiction, and more.

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

A list of free online interactive and PDF assessment tools for providers working with couples. (See Free Online Screening & Assessment Tools for additional screening tools.)

Relationship Satisfaction & Expectations

The Companionate Love Scale | Link to a PDF version of this scale to measure companionate love; scoring instructions not included

The Couples Satisfaction Index (CSI) | A 4-page PDF assessment to measure relationship satisfaction; scoring instructions included

Feeling Connected in Your Relationship? | An 18-question interactive quiz from PsychCentral

The Gottman Relationship Checkup | Sign up for a free account to access the online interactive assessment

How Deep Is Your Love? Quiz | A 15-question interactive quiz from PsychCentral

How Strong Is Your Relationship? Quiz | A 10-question interactive quiz from PsychCentral

The Marital Disillusionment Scale | Link to a PDF version of this assessment tool

Marital Satisfaction Survey | A PDF scale to evaluate marital satisfaction; click on link listed in the “Interactive Section for Couples”

The Passionate Love Scale | A PDF tool with scoring instructions

Perceived Relationship Quality Components Inventory (PRQC) | Link to a Word version of this scale to assess six components of relationship quality

Quick Compassionate Love Test | A 6-question interactive test from PsychCentral to assess compassion in a relationship

Relationship Assessment Scale | Link to a Word version of this scale with scoring instructions

The Relationship Expectations Questionnaire | A PDF tool; click on link listed in the “Interactive Section for Couples”

Sternberg Triangular Love Test | A 45-question interactive test from PsychCentral to assess intimacy, passion, and commitment

The Sustainable Marriage Quiz | A 10-question interactive quiz from PsychCentral

Attachment Styles

The Attachment Style Assessment | Interactive tool for assessing how you attach to romantic partners; you must submit your email to see your results

Attachment Styles and Close Relationships | Interactive surveys to determine attachment style

Diane Poole Heller’s Attachment Styles Test | Interactive assessment; you must submit your email to see your score

Measure of Attachment Qualities | Measures adult attachment styles (PDF)

Romantic Attachment Quiz | A 41-item quiz from PsychCentral to help you determine your romantic attachment style in relationships

Vulnerable Attachment Style Questionnaire (VASQ) | Links to PDF version of questionnaire and scoring instructions

Communication

The 5 Love Languages | A PDF assessment for assessing primary love “languages”

Interpersonal Communication Skills Inventory | A PDF self-assessment designed to provide insight into communication strengths and areas for development. Includes scoring instructions.

Interpersonal Communication Skills Test – Abridged | Interactive test from PsychCentral

Learn Your Love Language | An online quiz for couples to determine primary love language(s). (You are required to enter your information to get quiz results.)

Nonverbal Immediacy Scale | Online interactive tool for assessing differences in the use of body language when communicating; printable version here

Open DISC Assessment Test | Online interactive tool for assessing your communication style

Self-Perceived Communication Competence Scale | Printable scale with scoring instructions

Willingness To Communicate | Printable assessment with scoring instructions

Willingness To Listen | Printable assessment with scoring instructions

Domestic Violence & Sex Addiction

Danger Assessment Screening Tool | Clinicians can download a PDF version of this assessment, which helps predict the level of danger in an abusive relationship; this screening tool was developed to predict violence and homicide.

Domestic Violence Assessment Tools | Five assessments from the Domestic Shelters site

Domestic Violence Screening Quiz | Interactive test from PsychCentral to determine if you’re involved in a dangerous abusive relationship

Sexual Addiction Quiz | A brief screening measure from PsychCentral to help you determine if you are struggling with sexual addiction

Additional Relationship Assessment Tools

20 Question Self-Assessment for Healthy Boundaries | Download a PDF assessment created by Dr. Jane Bolton; scoring instructions not included

Brief Index of Sexual Functioning for Women (BISF-W) | Subscription required to access assessment tool

Desire to Have Children Scale | Link to a Word version of this scale

Emotional Intelligence Quiz | An online interactive test to measure how well you read other people

Empathy Quiz | An online interactive test to measure empathy

Evaluations of Attractiveness Scale: Female Attractiveness | Male Attractiveness | Online interactive tests for assessing preferences

Ideal Partner and Ideal Relationship Scales | Link to Word scales to assess ideal partner attributes and ideal relationship qualities

Interactive Behavioral Couple Therapy Questionnaires | 5 downloadable PDF assessments for couples

Jealousy Instrument | Link to a PDF version of this instrument; scoring instructions not included

Love Attitudes Scale | Link to a Word version of this scale that measures different love styles; scoring instructions included

Marital Forgiveness Scale-Event | Marital Forgiveness Scale (Dispositional) | Links to PDF versions of scales with scoring instructions

Marital Offense-Specific Forgiveness Scale | Link to a PDF version of this scale; scoring instructions not included

Perceptions of Love and Sex Scale | Link to a Word version of this scale with scoring instructions

The Relational Assessment Questionnaire | Link to a PDF version of this questionnaire (with scoring instructions) to measure relational aspects of self

Relationship Trust Quiz | An online interactive tool

Respect Toward Partner Scale | Link to a Word version of this scale (with scoring key)

Romantic Partner Conflict Scale (RPCS) | Link to a PDF version of this scale with scoring instructions; Word version also available

The Sexual Disgust Inventory | PDF scale with scoring instructions

The Spann-Fischer Codependency Scale | A 16-item scale (PDF) to measure codependency

Susceptibility to Infidelity Instrument | Link to a PDF version of this instrument and information on scoring

Trust Scale | PDF tool for assessing trust within close interpersonal relationships

Self-Care Strategies When Your Loved One Has an Addiction

Self-care is not a luxury; it’s necessary for survival when your loved one has a substance use disorder. By taking care of yourself, you gain the energy and patience to cope with your problems. Self-care promotes wellness and emotional intelligence; it puts you in a better space to interact with your loved one. Strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers.

By Cassie Jewell, M.Ed., LPC, LSATP

When your loved one has a substance use disorder (SUD), it can be overwhelming, distressing, and all-consuming. When we’re stressed, we forget to practice basic self-care, which in turn makes us even less equipped to cope with the emotional chaos addiction generates.  

In the book Beyond Addiction: A Guide for Families, the authors discuss the importance of self-care. This post reviews suggested strategies. (Side note: I strongly recommend reading Beyond Addiction if your loved one has an SUD or if you work in the field. This book will increase your understanding of addiction and teach you how to cope with and positively impact your loved one’s SUD by using a motivational approach. This is one of the best resources I’ve come across, especially for family members/significant others.)

Image by Pexels from Pixabay

Based on the premise that your actions affect your loved one’s motivation, taking care of yourself is not only modeling healthy behaviors, it’s putting you in a better space to interact with your loved one. Chronic stress and worry make it difficult to practice self-care. Self-care may even seem selfish. However, by taking care of yourself and thus reducing suffering, you gain the energy and patience to cope with your problems (and feel better too). Furthermore, you reduce the level of pain and tension in your relationships with others, including your loved one with a SUD. Self-care strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers. Therapy and/or support groups are additional options.

“An empty lantern provides no light. Self-care is the fuel that allows your light to shine brightly.”

Unknown

Resilience

The definition of resilience is “the capacity to recover quickly from difficulties” (Oxford Dictionary). Doctors Foote, Wilkens, and Kosanke wrote that having resilience is a way to “systematically reduce your vulnerability to bad moods, lost tempers, and meltdowns.” While you cannot “mood-proof” yourself entirely, resilience helps when facing life’s challenges, setbacks, and disappointments. To maintain resilience, one must practice at least the most basic self care practices, which are as follows:

  1. Eat well
  2. Sleep well
  3. Exercise enough
  4. Avoid mood-altering drugs (including alcohol)
  5. Treat illness (with prescribed medications, adequate rest, etc.)
Image by Irina L from Pixabay

Self-care is not something you can push in to the future. Don’t wait until you have more time or fewer obligations. Self-care is not a luxury; it’s a necessity. The authors of Beyond Addiction pointed out that self-care is something you have control over when other parts of your life are out of control. If you find it challenging to implement self-care practices, tap into your motivations, problem-solve, get support, and most of all, be patient and kind with yourself.

“Taking care of yourself is the most powerful way to begin to take care of others.”

Bryant McGill

Distress Tolerance

On tolerance, Doctors Foote, Wilkens, and Kosanke suggested that it is “acceptance over time, and it is a cornerstone of self-care.” Tolerance is not an inherent characteristic; it is a skill. And like most skills, it requires practice. However, it’s wholly worth the effort as it reduces suffering. By not tolerating the things you cannot change (such as a loved one’s SUD), you’re fighting reality and adding to the anguish.

Techniques for distress tolerance include distracting yourself, relaxing, self-soothing, taking a break, and creating positive experiences. (The following skills are also taught in dialectical behavior therapy (DBT), an evidence-based practice that combines cognitive behavioral therapy techniques and mindfulness. For additional resources, visit The Linehan Institute or Behavioral Tech.)    

Distract Yourself

  1. Switch the focus of your thoughts. The possibilities are endless; for you, this could mean reading a magazine, calling a friend, walking the dog, etc. The authors of Beyond Addiction suggested making a list of ideas for changing your thoughts (and keeping it handy).
  2. Switch the focus of your emotions. Steer your emotions in a happier direction by watching corgi puppies on YouTube, reading an inspirational poem, or viewing funny Facebook memes. The writers of Beyond Addiction suggested bookmarking sites in your Internet browser that you know will cheer you up.
  3. Switch the focus of your senses. This could mean taking a hot shower, jumping into a cold pool, holding an ice cube in your hand, walking from a dark room to one that’s brightly lit, looking at bright colors, listening to loud rock music, etc. Also, simply walking away from a distressing situation may help.
  4. Do something generous. Donate to your favorite charity, pass out sandwiches to the homeless, visit a nursing home and spend time with the residents, express genuine thanks to cashier or server, etc. By redirecting attention away from yourself (and directing energy toward positive goals), you’ll feel better. In Beyond Addiction, it’s noted that this skill is especially helpful for individuals who tend to ruminate. Also, it’s important to brainstorm activities that are accessible in the moment (i.e. texting a friend to let them know you’re thinking about them) that don’t take multiple steps (such as volunteering).
Image by congerdesign from Pixabay

Relax

“Body tells mind tells body…” Relaxing your body helps to relax your mind. It also focuses your thoughts on relaxing (instead of your loved one’s addiction). What helps you to relax? Yoga? A hot bath? Mindful meditation? (I recommend doing a mindful body scan; it’s simple and effective, even for the tensest of the tense, i.e. me.)

Soothe Yourself

In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small techniques can make a big difference in your life by creating comfort and reducing out-of-control emotions.

Take A Break

“Taking a break” doesn’t mean giving up; it’s a timeout for when you’re emotionally exhausted. Learn to recognize when you need to step away from a situation or from your own thoughts. Find a way to shift your focus to something pleasant (i.e. a romantic movie, a nature walk, a day trip to the beach, playing golf for a few hours, traveling to a different country, etc.)

Image by Free-Photos from Pixabay

Create a Positive Experience

Doctors Foote, Wilkens, and Kosanke refer to this as “making it better,” not in the sense that you’re fixing the problem (or your loved one), but that you’re making the moment better by transforming a negative moment into a positive one. Suggested techniques include the following:

  1. Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
  2. Meditate or pray. As explained in Beyond Addiction, “meditation or pray is another word for – and effective channel to – awareness and acceptance. Either one can open doors to different states of mind and act as an emotional or spiritual salve in trying moments.”
  3. Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
  4. Find meaning. The authors of Beyond Addiction wrote, “Suffering can make people more compassionate toward others. Having lived through pain, sometimes people are better able to appreciate moments of peace and joy.” Suffering can also inspire meaningful action. What can you do to find meaning?
  5. Borrow some perspective. How do your problems look from a different viewpoint? Ask a trusted friend. You may find that your perspective is causing more harm than good.

Perspective

Perspective is “an understanding of a situation and your reactions to it that allows you to step back and keep your options open… [it’s] seeing patterns, options, and a path forward” (Beyond Addiction).

When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent. By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.

Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date. Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.

Trish is frustrated; she believes Dave is lazy and lacks self-control. When she nags about his drinking, he promises he’ll cut back, but never follows through. Trish thinks he’s not trying hard enough. She can’t understand why he’d choose booze over her and the kids; sometimes she wonders if it’s because she’s not good enough… maybe he would stop if she was thinner or funnier or more interesting?  At times she feels helpless and hopeless and others, mad and resentful; she frequently yells at Dave. She wonders if things are ever going to change.  

Image by Luis Wilker Perelo WilkerNet from Pixabay

A different perspective would be to recognize that Dave has an alcohol use disorder. He feels ill most of the time, which affects his mood, energy level, and motivation. He wants to cut back, but fails when he tries, which leads to guilt and shame. To feel better, he drinks. It’s a self-destructive cycle. If Trish understood this, she could learn to not take his drinking personally or question herself. Her current reactions, nagging and yelling, only increase defensiveness and harm Dave’s sense of self-worth. Alternative options for Trish might include learning more about addiction and the reasons Dave drinks, bolstering his confidence, and/or creating a supportive and loving environment to enhance motivation.

Triggers

In recovery language, a “trigger” is anything (person, place, or thing) that prompts a person with SUD to drink or use; it activates certain parts of the brain associated with use. For instance, seeing a commercial for beer could be triggering for a person with an alcohol use disorder.

You have triggers too. For example, if your loved one is in recovery for heroin, and you notice that a bottle of opioid painkillers is missing from the medicine cabinet, it could trigger a flood of emotions: fear, that your loved one relapsed; sadness, when you remember the agony addiction brings; hopelessness, that they’ll never recover. It’s crucial to recognize what triggers you and have a plan to cope when it happens.

Therapy and Support Groups

Lastly, therapy and/or support groups can be a valuable addition to your self-care regime. Seeing a therapist can strengthen your resilience and distress tolerance skills. Therapy may provide an additional avenue for perspective. (Side note: A good therapist is supportive and will provide you with tools for effective problem-solving and communication, coping with grief and loss, building self-esteem, making difficult choices, managing stress, overcoming obstacles, improving social skills/emotional intelligence, and better understanding yourself. A good therapist empowers you. A bad therapist, on the other hand, will offer advice and/or tell you what to do, disempowering you.)

Image by HannahJoe7 from Pixabay

Regarding support groups, there are many options for family members, friends, and significant others with a loved one who has a SUD, including Al-Anon, Nar-Anon, and Families Anonymous. Support groups provide the opportunity to share in a safe space and to receive feedback, suggestions, and/or encouragement from others who relate.


“I have come to believe that caring for myself is not self indulgent. Caring for myself is an act of survival.”

Audre Lorde

In sum, self-care is not optional; it’s essential for surviving the addiction of a loved one. Self-care enhances both overall wellness and your ability to help your loved one; in order words, take responsibility for your health and happiness by taking care of yourself.

For more information on how you can help your loved one, visit The Center for Motivation and Change.

3 Reasons We Keep Toxic People in Our Lives

Why do we keep toxic people in our lives? Despite the emotional costs, many people chose to remain in toxic relationships. This post explores the emotional reasoning behind not letting go.

By Cassie Jewell, M.Ed., LPC, LSATP

Recently, an acquaintance told me about breaking up with his girlfriend. Listening to his story, I both cringed and laughed at the sheer ridiculousness of it. (Think The Break-Up meets Fatal Attraction.) His humorously-told narrative left me wondering, how on earth did it get to that?

It began when his at-the-time girlfriend “secretly” moved in with him. At first, she’d stay for a night or two, which eventually turned into weeks at a time, until all her stuff was there and my friend found himself with a live-in girlfriend. (It’s worth mentioning he’d seen a few “red flags” early on, but chose to ignore them… as we often do under the spell of infatuation.) Now living with her, he couldn’t turn a blind eye to the fact that she had some serious mental health and interpersonal issues. Furthermore, the relationship had taken a turn for the worse; they were constantly fighting.

So, my friend (wisely) broke up with her and told her to get out. And… she refused. (Really??) She claimed there was a law permitting her to stay since she’d been there for X amount of time. (Note: This is also when he found out she was homeless.)

He kicked her out of the bedroom (and she slept on the couch). To “encourage” her to leave, he took her parking pass, along with her new iPhone (which he undoubtedly bought in a more amiable era). To further “motivate,” he even shut off her cell service.

Despite his efforts, weeks stretched on; she continued to live (rent-free) on his couch.

To make a long story short… she eventually left. (Otherwise, I wouldn’t be writing this blog post) … but not until the apartment manager and police got involved. (It turned out her tenant rights claim, while valid, was not actually applicable to her situation.)

My initial reaction to the whole fiasco was incredulity – Seriously, how could he let it go that far? – but after reflecting on past relationships… it was suddenly very easy to understand. (I’ve made my fair share of relationship mistakes.)

The reality is, it’s never as simple as “it’s over, get out.” Relationships require a certain level of emotional investment and commitment. Plus, there are multiple factors (such as debt, illness, or infidelity) that contribute to a relationship’s complexity.

Back to my friend… to be fair, the reason he remained in a toxic relationship was her refusal to vacate the apartment; his options were limited… but, instead of allowing it drag on, he could have taken action earlier.  Anyway, the story has a happy(ish) ending (for my friend, probably not his ex). He has his place back (hopefully a lesson learned) and got free blog inspiration. This post is 100% inspired by my friend’s toxic relationship. (Thank you for letting me share!)

(Apart from “tenant rights”) what are reasons we allow toxic or difficult people (friends, family, and/or romantic partners) to remain in our lives? Why is it so hard to let go?

  1. Either you need them (or you can’t ignore them)

A recent study suggests we keep toxic people around simply because their lives are intertwined with ours. For example, your aging mother-in-law, who degrades and insults you, lives at your home, despite the negative impact this has on your life. Your options are limited because your husband is unwilling to put her in a nursing home (and you may also depend on her for things, like childcare or help with the bills).

Another example would be toxic co-workers; you don’t have a lot of choice when it comes to your boss or colleagues, and you can’t entirely avoid them or refuse to talk about work-related stuff (unless you’re okay with losing your job). If pursing a new position isn’t practical, your next best option is to find a way to effectively deal with workplace toxicity.

That being said, you don’t have the power to change anyone else. To manage your reactions and interactions with toxic people, acknowledge the need for self-adjustment, including attitude and role. Examine your personal views. Lower expectations for others; accept that people will do and say things you don’t agree with… and it’s not something you can control. Once you’ve reached the point of radical acceptance, follow guidelines for effective communication (i.e. active listening, avoiding blame, being aware of tone and body language, reflecting for clarity, etc.) in conversations with toxic people, whether it’s your mother-in-law or your boss. By being proactive, you’re doing your part to avoid getting caught up in others’ toxicity.

In the face of unavoidable toxicity, I find switching to a “counselor role” to be a tremendous asset; I set aside my personal viewpoint, opening myself to alternative views, while seeking to understand (not judge) behavior. (You don’t have to be a counselor to do this!) I view individuals in terms of “what happened to you?” instead of assuming they’re malicious or intentional. (People act the way they do for some reason.) I don’t know what’s happening in a “toxic” person’s life or what they’ve been through. (Maybe that snarky co-worker is in an abusive relationship and lives in fear. Or maybe her son is in the hospital with brain cancer. Or, it’s possible she grew up in a home where her parents yelled and disrespected each other, shaping her view of relationships. The snarky attitude makes sense when viewed through different lenses.) While it’s never okay to be an asshole, I can understand why people are jerks. Somehow, this knowledge serves as an immunity when encountering a toxic person. Their behavior is the result of something bad that happened to them; it has nothing to do with me and I can choose whether or not to engage. They don’t have power to negatively impact me unless I give it up.

  1. It feels better to stay

When Joe Strummer of the Clash sang the question, “Should I stay or should I go now?”; he knew the answer. (Note: Firm boundaries and healthy decisions aren’t the stuff of chart-topping hits.) We stay in unhealthy relationships or continue to hang out with toxic friends because it feels good (at times, at least). The boyfriend who yells at you can also be incredibly sweet and caring. Or your gossipy friend who talks about you behind your back also happens to be the most fun person you know. Despite the sense that it’s unhealthy, you (like Strummer) can’t resist. And like my friend, you ignore the red flags because you crave the rush or the intensity… or maybe what you desire most is the feeling of being wanted. (Despite the toxicity, it’s worth it, just to feel wanted… or is it?)

Beyond just feeling good, it’s entirely possible to deeply love a toxic person (no matter how wrong they are for you). You don’t want to give up on the person they could be; maybe you’re in love with their potential (or an idea of what the relationship could be). You believe it’s better to sacrifice your happiness (your dignity, your well-being, your independence) than to be without the person you love.

On the flip side, some people stay in toxic relationships because deep down, they believe they can’t do any better and/or the abuse is a preferable alternative to being alone. It could also mean they believe they deserve to be punished (which sometimes happens when a person remains in an abusive relationship for a long time). Or, they may reason that it’s better to hang out with a “mean girl” than sit and stare at the walls on a Friday night (with only the cat for company).

If you can relate to staying in a toxic relationship because it feels good or are afraid of being alone, carefully consider and weigh out the long-term costs of a toxic relationship. There are far worse and more damaging things than being alone. If the idea of being alone terrifies you, maybe it’s an indication that something’s not right… that you’re not okay. It could be a sign of low self-worth or could point to an intense fear of abandonment. It may also signify a lack of understanding of what it means to be in a healthy relationship. Lastly, an intense fear of being alone is associated with some of the personality disorders and/or could be the result of trauma.

  1. It’s (So Much) easier to stay

Breaking up is messy and uncomfortable. In my experience, most people avoid conflict when possible. Despite conflict being a natural, everyday occurrence, it can feel unpleasant, even for those with expert conflict resolution skills. However, avoiding conflict in relationships does more harm than good. In a healthy relationship, it’s necessary to address problems in order to resolve them, thereby strengthening the relationship.

In a toxic relationship, conflict should not be avoided, but for different reasons. It may be easier to ignore the reality of your situation than to get honest, but this is detrimental (not only to you, but to your partner, who will never have the opportunity to change so long as you enable the toxicity to continue).

You may wish to avoid the emotional drain that accompanies confrontation, but in the long run, you’ll lose more emotional energy if you remain in a toxic relationship. (A steep, one-time payment is preferable to the ongoing, daily emotional sacrifices/abuses associated with toxicity; you’re slowly poisoned as time goes on.)

If you choose to end a toxic relationship, be realistic; it’s not going to be easy… and it’s going to hurt. A lot. You may love this person a great deal (and maybe you’ve long held on to the hope they’d change). Go into it with low (or no) expectations. When things feel unbearable, remember that the easy things in life matter little; the difficult stuff is what leads to personal growth, success, and resilience.

In closing, I’m sure there are multitudes of reasons people have for staying in toxic relationships; this post is by no means comprehensive. I’m also certain, whatever the reason, it seems justifiable to them. People don’t choose toxicity without some sort of justification (if not for others, than at least for themselves). Unfortunately, rationalizations don’t offer protection from harm. No matter the reason for remaining in a toxic relationship, it’s not worth the cost.

What are other reasons people have for staying in a toxic relationship? Why is letting go so hard? Share your thoughts in a comment!


References

Bar-Ilan University. (2018, January 17). Why we keep difficult people in our lives. ScienceDaily. Retrieved July 14, 2018 from http://www.sciencedaily.com/releases/2018/01/180117152513.htm

Offer, S., & Fischer, C.S. (2017). Difficult people: Who is perceived to be demanding in personal networks and why are they there? American Sociological Review, 000312241773795, DOI: 10.1177/0003122417737951