I recently had a patient with a lot to process. Every so often during the session, she'd throw out questions asking for advice on random life problems, like looking for a quick solution. I get it. A lot of people come into therapy with the goal of problem-solving, of finding strategies to fix things. But here's the reality: We can't fix what’s broken when the foundation is crumbling beneath us.
In this particular case, I had to hit pause. While I’d casually respond to some of her specific questions, I made it clear that what concerned me most was her ability to take care of her foundational needs. Problem-solving, strategizing—those come later, when there’s a solid base to build on. It reminds me of my time working in inpatient settings at state prisons, where I dealt with people at some of the darkest points in their lives. They weren’t there to come up with a five-step plan for their trauma. No, they were there just trying to survive the moment, the hour, the day.
In those cases, I wasn't diving into deep therapy work right away; I was monitoring the basics—are they eating? Are they drinking enough water? Are they sleeping? Do they shower regularly? These things were crucial. You can’t move forward when the fundamental steps of living aren’t being met. It's only after those patients stabilized, after they were eating well and getting some rest, that we could consider releasing them to continue the deeper work in outpatient therapy.
Now, in private practice, I’m lucky to work with people who are, for the most part, highly functioning. They don’t need me to monitor their hygiene or diet. But even with high-functioning patients, when someone tells me they're constantly tired, stressed, overwhelmed, and anxious, I look at the therapy basics: sleep, nutrition, hydration.
Let’s Talk About Sleep
Are you rested? Can you handle the daily stressors life throws at you without feeling on edge every minute? Sleep is one of the most critical aspects of mental and physical health, and I talk about sleep hygiene on a near-daily basis in my sessions. There’s clinical evidence that improving sleep quality reduces stress, enhances emotional regulation, and boosts overall well-being. If you're struggling with anxiety or depression and aren’t sleeping well, we need to address that first. I’m not going to throw in cognitive restructuring techniques or delve into trauma work if you’re exhausted.
Are You Eating Enough?
Here’s another one: How are you fueling your body? If you're starting your day on an empty stomach, running from meeting to meeting, emails nonstop, and the first meal you eat is late at night—yeah, we’ve got a problem. Your body isn’t getting the fuel it needs to keep up with the mental and emotional energy demands you’re placing on it. If you’re irritable, overwhelmed, or snapping at your partner, and you haven’t eaten all day? That’s not a mental health problem—that’s a basic biological need screaming for attention. Balanced nutrition supports cognitive function and emotional stability. No balanced meals? No energy to dive into the deeper stuff.
Hydration, Too
Lastly, water. Drinking enough water is a foundational part of taking care of your body. Being dehydrated affects mood, focus, and energy levels. It's so basic, but often overlooked.
The bottom line is this: If you're starting therapy and telling me you're constantly tired, stressed, and anxious, we're going to focus on the basics first. Are you sleeping? Are you eating regularly? Are you drinking enough water? Once these needs are stabilized, then we can move on to the deeper, more complex issues. Trying to tackle big, meaty psychological work when you're running on empty is like trying to build a house on sand. You need a strong foundation for anything to stand.
So, if you find me talking about sleeping, eating, and drinking water on a near-daily basis in our sessions, it's because I understand that your mental health depends on it. Once these foundational needs are met, then we can dive into the deeper work with more success.
This is where true healing begins.
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