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TRIGGERING TRANSITIONS

This is a transcript of Live the 8Wise™ Way Podcast.

Episode Thirteen:

Triggering Transitions                                                        

Welcome everybody. This is episode 13 of the Live the 8Wise Way podcast with me, Kim Rutherford, psychotherapist, author and brainchild, I guess you can call me, of the 8Wise model for better mental health and wellbeing. I’m also now a podcast host as well.

I hope you’re doing well. How are you all? If this is your first time joining me on this podcast, thank you so much for coming along. I hope you get what you want from it, I hope you get what you need from it and if it is your first one, why not jump on to see some of the previous episodes as well and really start learning to Live the 8Wise Way from the very, very beginning. All of the episodes up until this point have been linked directly to my book, 8Wise Ways to a Healthier, Happier Mind which, if you haven’t got a copy and you want to get a copy, you can get that pretty much anywhere that sells books, so you can either come to me directly on my website which is www.8wise.co.uk and there’s a store there where you can access them directly, or you can go to all of the other big boys, you know, the Amazons and the Waterstones and everywhere else that sells books as well. The choice is yours. You can get the book in either paperback, hard back or Kindle versions as well. I’m really, really excited to be telling you that, if you are somebody who prefers an audiobook, then the audiobook will be with you for the end of this year, just in time for you to use it to help you with your new year’s resolutions and hopefully make 2023 the year that you are Living the 8Wise Way for better health, better mental health, better wellbeing, and more importantly, just a really, really good quality of life.

So, in all of the previous episodes so far, I talked you through the 8Wise process, the 8Wise model, the four dimensions and the eight core elements that make up what we call your wellness spectrum and how having different life events happening all the time, and how you respond to those life events, triggers your wellness spectrum and that’s what then can lead you into the downward spiral towards poor mental health. The great thing about 8Wise, as I’ve said, it’s a prevention model, it’s a recovery model, so if you are currently working with a clinic or a team of specialists whilst you work through mental health issues or manage or learn to manage a mental illness, then you can still use 8Wise to help you with that recovery process, but if you have not, or do not have any mental health issues currently and are doing your very best to try and manage that to make sure that you don’t have them and you want to use something as a prevention tool, then 8Wise is that for you as well. It helps the one in four who’ve got mental health issues and it helps the three in four who are at risk.

So, if you want to grab a copy of the book, then as I said you can head to my website or head anywhere else and then you can also use that to listen to all the other episodes of the podcast and almost use it as your own, I guess you could call it your self-guided psychotherapist in your own hand, whilst you sit wherever you sit listening to me do all of this right now. But the whole point of teaching people about 8Wise is so that you know how you can implement it into your life, because the reality of it is, let’s be honest, life’s tough and we spend most of our life responding to the things that are thrown at us. So what I want to talk about today is some of those really big things that are thrown at us and that cause us some of our mental health issues or definitely cause us some of our psychological challenges on a day to day basis. I like to call these life challenges and transitions.

Now way, way, way, way back and right at the beginning of the book, I think it’s in chapter one, I talk about what the meaning of life is. For me, I explain it as the meaning of life has two core elements to it. I have this belief because I link it to these psychological and biological processes that take place in our body.

So, the first meaning of life from my perspective is for survival, for the individual human to survive and we have this inbuilt system, our fear, fight flight process that provides us with the ability to do that. We have a chemical reaction in our body, our body actually changes, our mind changes in those moments when we need to really look after ourselves and go into survival mode and so, from my perspective, one of the core meanings of life is for the individual to survive for as long as they possibly can.

The second meaning of life, from my perspective and from what my understanding is, is to evolve as a human species. So, the individual has to survive in order to be able to learn and gather data and gather information and anything that is going to help that individual human pass that information down to the next generation and the next generation. So that generation after generation we can keep growing, we can keep learning and ultimately as a species, we can keep evolving. And because we keep evolving, that means that we continue to survive as a species as well.

For me, it’s about using that fear, fight, flight process in order to survive as an individual and then that allows us to live longer and use our learning processes, the parts of our brain that allows us to learn and retain information and communicate that to others in order to then pass that information down and as a species to evolve from that.

Now because we have these two processes, evolution is a change, but it’s a very, very, very slow change. It isn’t something that happens quick and overnight and so we’re built for that, we’re built for this slower process, this way of learning and developing and growing slowly so that the next generation benefits and the next generation benefits. When it comes down to rapid change or quick change, we are not really built for that in the same way. Now, don’t get me wrong, we can do it and there’s a few people out there who will say, and I get messages all the time when I talk about this, I get people saying “I thrive in change, I love change, I’m thriving in change”. I’m not saying that you’re not because what’s happening is a lot of change brings a lot of fear and that fear can be really, really great if we are pushing all of those chemicals and all those hormones in the right direction that are triggered through it. But on a day-to-day basis most of us are not coping with change very well. We tend to like habitual processes and so change can cause us quite a lot of challenges. That’s the whole point of life challenges and transitions because we go through so many life challenges through our transitions because, as we evolve in our own personal individual lives, for as long as our personal and individual life span can be, we’re going through so many transitions and we’re having to constantly change and that in itself, as I’ve said, causes us some problems. So I think it’s really important that we start to look at life challenges and transitions and understanding what they are, understanding how they impact our day to day lives and how they impact how, well, basically, how we think and how we feel and how we behave and how our bodies respond and how that impacts our overall wellness spectrum and ultimately how you can then use 8Wise to help you to manage those transitions as well.

I want to just explain to you some information about the transition so you’ve got a better understanding and then you can start to analyse and assess your own life and identify for yourself are you currently in a transition, have you come out of a transition, are you heading into a transition and understanding what they look like and maybe what you can do about it as well.

So, let’s start at the beginning. Ultimately, life transitions, there are these periods in our life that involve lots of change to the lifestyle that we currently live. It might be a result of important events that make you stop and evaluate your life or they might just be things that you know that you have to go through at some stage because growing up enforces that upon us. But ultimately life transitions are these periods of life which involve lots of change to the lifestyle that we have at that moment in time.

To give you some idea of what that might mean and what that might look like and what different life transitions might include. So, starting or ending a relationship is a transition, getting married or getting divorced, having children or choosing to adopt children, that’s a huge transition, starting a new job or a new career or leaving a job is a huge transition, huge transition because our careers, as we know through occupational wellness, have such a big impact on our lives. Going to school, going to college, going to university, no matter what age you’re at is a big transition, it’s lots of learning, lots of growth, a lot of impact on our intellectual wellness. Buying or selling a home is a huge transition. We go back to the basics of Maslow with regards to our fundamental foundation, we need to have this roof over our head for safety and security, to go through the concept and go through the process of buying or selling a home we have to almost give up the thing that we feel safe and secure with and move towards something that we have to create safety, we have to create security in, in our environmental wellness.

Other transitions include health issues and those of us who experience health issues and have to have major lifestyle changes because of that, sadly loss or death, bereavement itself brings a major life transition. Then we have the ones that are linked to our financial losses and gains in life as well. Now, just by talking through those, for those of you have gone through the other 12 episodes, you’re probably looking at it going “okay, yeah, I understand this now”, so the relationships one, that’s the transition that links to social wellness. It makes sense. Children links to social wellness, but also links to spiritual wellness from a fulfilment, a purpose perspective. Starting a new job or attending a school or giving up a career that links into occupational wellness, but also spiritual wellness because it’s part of who we are. Buying or selling our home is our environmental wellness, health issues are physical wellness, financial gain or loss that’s our financial wellness, death or loss is emotional wellness.

So all of our wellness spectrum, all eight elements of the wellness spectrum are touched upon just through those basic examples of transitions and challenges that we face. Ultimately what you need to think about when you hear the concept of transition is that it means change, it means loss, it means endings and beginnings and there are four different types of life transition that you can experience. What I want you to do is I want you to have a think of your life so far, no matter what age you are, have a think of have you experienced any of these transitions to date already, are you currently experiencing one of these transitions or are you in the process of preparing to experience one of these transitions.

Transition number one to be thinking about, we call this the anticipated transition. So it’s expected to happen in your adult life, so you know it’s going to happen, you’ve planned for it, but it might still feel a bit uncomfortable as you adapt to that transition. These are the transitions that culturally we’re aware are going to happen to us and they’ve been a part of our lives since we were very young, which is why we’re prepared for it. So anticipated transitions are things like having to start school, having to leave school, having to do exams, things like getting a job, changing careers, meeting somebody maybe, getting engaged, getting married, buying a house, moving house, maybe having children. Whatever it is that you’ve known from an early age, that you’ve wanted to be a part of your lifestyle as you grow up and as you move through your own ages, they’re the anticipated transitions. We know that even though you are planning for them, it doesn’t mean that they’re going to be easy when you start to experience them and they can still be incredibly uncomfortable.

Let’s just look, for example, let’s look at having a baby or having children. We go into it and we know we want to have these families and we have almost this romantic concept of what raising a family will be like and that’s good, we have to have that in order to make us want to do it because, you know, if you looked at having children on paper, you probably wouldn’t want to do it. It doesn’t look great on paper. It’s experiencing having a family that makes people want to have children and want to move forward with having a big family. But having a baby itself brings a major transition. For a woman, obviously the pregnancy process alone is a huge transition, both psychologically and both physically. Then when the baby is here, that’s another transition, a whole lifestyle change, and it’s a lifestyle change that continues to change as the child grows and develops as well. So there’s a lot of unease, a lot of uncomfortable moments, a lot of amazing moments as well, no doubt about that, but there is a lot of uncomfortable, difficult, challenging moments as the transitions happen and there’s a lot of people who experience, when they have their a child for the very first time, it’s very difficult and it can bring on a lot of anxiety and a lot of depression and mental health issues because that transition is so strong. So that is an anticipated transition. Have you experienced an anticipated transition so far, what was it like for you, was it uncomfortable, did you survive it well, what would you do if you could go back in time and tell yourself how to prepare better for it, what would you tell yourself. Have a think about the anticipated transitions you’ve experienced and how well you adapted to them, how well you’ve managed them, how were you affected by the challenges that come with the transition and if you haven’t yet had them and you are on the path to that process and you’re moving towards these things, then now’s the time to have a think about it. Have a think about how changing your lifestyle so dramatically, even if it is for brilliant reasons and exciting reasons and all of the experiences you want to have in life, it’s worth thinking about where are those challenges, where might the bumps in the road be and do I have my wellness spectrum in place, is it strong enough, is it balanced enough, do I know what my mental health tools are, do I have a really good self-care plan in place so that when those bumps in the road do come, you are ready and prepared for them as best as you possibly can be.

So they’re the nice ones. They’re the anticipated transitions. They’re the ones that come with excitement and we are looking forward to sometimes. On the flip side of that though, obviously we can’t always anticipate everything, so we have the unanticipated transition.

Now these are the transitions that have not been planned for at all. So, because they’ve not been planned for, they do not fit in with your life, they do not fit in with your plans and they are not something that you are anticipating in any way, shape or form. These ones can be really, really stressful, incredibly painful in comparison to what the anticipated transitions are and can bring us major, major issues with our mental health predominantly because these increase our day-to-day stress levels so dramatically.

Examples of our unanticipated transitions are redundancy, we start jobs and we think we’re going to be there for as long as we need to be and before we know it businesses don’t work out and we could be losing those jobs and that creates major issues for us from an occupational wellness perspective, because suddenly we don’t have that job, we don’t have that daily purpose. It can really affect us on a social wellness level because suddenly those people that were our social support systems every day are no longer in our lives anymore when we leave those workplaces in the same way. It can affect our spiritual wellness because suddenly “why us, why were we picked, weren’t we good enough”. We start to question ourselves, so it starts to impact our belief system and it starts to affect our self-esteem issues. Then also that can then trigger our emotional wellness and our physical wellness as well. You can already see that just redundancy as one unanticipated transition on its own can have a major effect.

Others are things like illnesses, accidents, and relationship breakdowns. None of us get in a car every day and think something bad is going to happen or otherwise we’d never get in the car. To be honest on the days after my car crashed, when I thought something would happen every day, I genuinely didn’t get in the car because I was too petrified of any unanticipated transition that might happen. But it’s like relationship breakdowns, no one gets married, for example, to get divorced. Nobody starts a relationship knowing it’s going to end because we’re optimistic at our core and we’re trying to really create wonderful things and create plans for our future and cement our future. These unanticipated transitions can be very painful, very stressful, and can trigger a lot of issues for us with regards to our overall mental health as well.

Now we move on to some of the other transitions. So, if we’ve gone from anticipated to non-anticipated, now we’re moving on to non-event transitions. So once upon a time we had an anticipated transition, and we were looking forward to it happening and it was going to happen, we planned for it and we looked forward to it and we built our lives around it, we geared our lives up to be able to achieve that transition and accepted that there were going to be some challenges and some bumps in the roads. Then a non-event transition can happen, and this is when there is an absence of that expected event. So something you are expecting does not happen and you then have to manage the grief and the loss that goes with this very specific transition.

Examples of this are things like if you don’t get promoted and you’ve pretty much been told the job’s yours and you go for that interview and they choose someone else, that’s painful. Not being able to have children if all you’ve ever wanted to do is have children. On the flip side of that is obviously a loss of a child in any way, shape or form and also in comparison to death, the smaller things such as the house that you’re aiming to buy falls through or the person just pulls it back and doesn’t want to sell it. These are just very small few examples of what a non-event transition is, but it’s basically when all of your expectations are ready, you’ve built your life up around this moment, this big lifestyle change, you’re prepared for it. Everything about you is prepared for it and then it’s as if it just gets popped, as if the dream gets popped, the rug gets pulled from under you and what you are left with is this empty space that was once filled with planning and dreams and hopes and optimism and almost a vision of what your future was going to look like. It can feel very much like you need to rebuild when you’ve experienced a non-event transition. This can hit you really, really hard. As I said, unanticipated transitions can hit you hard because we just weren’t expecting them, but to expect something and then it does not happen, that’s really very painful. It’s almost like there’s always an empty space, there’s always an elephant in the room that you can’t see, you can’t feel because it’s the space that should have been filled with something else and it can take a long time to come up to get over that. You can imagine that those non-event transitions, they trigger absolutely everything, a big grief and loss cycle, so we’re looking at emotional wellness is triggered, physical wellness is triggered, spiritual wellness is triggered. If it’s linked to people, it can be social wellness triggered. If it’s linked to work, it can be occupational triggered. If it’s linked to the fact that you’ve not moved into your own home or you’ve lost your home, and then it’s going to be triggering your environment as well. It triggers everything sadly, that absolutely triggers everything. So that’s your non-event transitions. One of the most painful transitions you can experience.

Then we’ve got probably, maybe it’s the nicest of all the transitions, we call this the sleeper transition, and the thing is with a sleeper transition, these are the transitions that are happening without you having any awareness of them whatsoever. They basically, and literally, just sneak up on you gradually improving who you are and developing you and leading you towards personal and professional growth. Your sleeper transitions are those that have the ability to move you out of your comfort zone for example, they’re the ones where you’re making small changes every single day so you don’t feel this overwhelming impact from the transition. Instead, it’s more of a case of, through self-reflection and looking back on your own timeline and seeing how far you’ve come, you can then turn around and say “ah yeah, done pretty good, check me out”. Sometimes obviously these sleeper transitions might not be so great either. If you’ve ever experienced seeing a friendship come to an end, for example, that tends to happen on a very slow process. We don’t necessarily see it coming until it’s right there. Some examples, positive examples as well of sleeper transitions are parenting. You start the role not having a clue what to do and before you know it, just through these small little actions that you take every day, these small changes, the way that you adapt, you’re constantly moving forward and through that constant moving forward, you’re transitioning, transitioning, and transitioning. Before you know it, you’re a phenomenal parent and you can look back and you can tell all of the new parents how to do it.

Learning a language is another sleeper transition. You have to start with just a couple of words and then before you know it you keep using those words on a regular, regular basis and before you know it, you can actually speak a different language. For those of you who are like me, I learned French at school and I can tell you now I cannot speak French fluently so fair play to anybody who can, and I respect the French language greatly but when I was in France very recently, I was able to link back into some of that learning and it is really surprising how much information you retain, even though you’re not using it all the time. I went through my own sleeper transition whilst I was in France, because as soon as I started using the language again, I was able to bring out some of the language and actually speak to people in a way that I hadn’t used that language in, well I’m a little bit older, so at least 20 years I hadn’t spoken any form of French and now I could. Could I do it today? Probably not because it’s probably all gone back to sleep again, but it’s lovely to know that my sleeper transition allowed me to develop it and whilst I was there on a day to day basis, by just using it a little bit, a little bit, a little bit, by the end of the week,I was feeling really, really confident, not fluent in any way, shape or form, but confident enough to get by and not insult too many people I hope.

Other examples of positive sleeper transitions are getting better with your fitness goals so if you are somebody who’s really into your fitness. One of my dreams was always be able to run when I was younger, I was very fast and I could run and then I got older and slower and lazier is the bigger issue and then I started putting some time and effort into my fitness recently and before I knew it my fitness has improved and improved and improved and it’s quite strange to go back and do an exercise six weeks later that six weeks prior I couldn’t do. Then six weeks later you do it again and you can do it. That’s a sleeper transition. That’s something that by constantly moving, you don’t have to do a lot of movement but by constantly moving your body is changing, you’re getting fitter and fitter and fitter, and that’s a really good positive sleeper transition that has an amazing impact on your overall health and wellbeing.

Now with every positive example, sadly must come some negative examples as well. So things like being really demotivated at work, this is a sleeper transition. This comes upon you. You might have been the most motivated person in the world and then life has been throwing its stuff at you, you’ve been adapting to it, responding to it, trying to cope with it, trying to manage it, and it can impact your motivation at work so before you know it, you can become demotivated. Also, the one I mentioned previously, the disconnecting with friendships or relationships fizzling out, it’s one of those sad, sad things that happens. It’s one minute you could be absolutely best friends with somebody and then before you know it, and I think Covid has had a huge impact on this for an awful lot of friendships and an awful lot of relationships, things start to change and you don’t notice them when they first start to happen. This is not just friendships, this can be any everyday relationships, it can be relationships with your friends, with your family, with your colleagues, it can be intimate relationships. That these small changes can happen every single day that actually create a distance within those friendships and that distance can then stop the communication in those relationships as well and it’s that lack of communication, before you know it, it’s the sleeper transition towards these relationships fizzling out. A lot of the time we don’t even realize that this has happened until it’s at its worst stage. Of course, we’ve got the opportunity and the options to change that and turn it around if we want to, but I’m sure there’s many people listening to this right now who’ve had friends that were great friends once and they just don’t have much to do with them anymore and you don’t dislike them, you don’t wish them any ill harm, they’re just not in your life anymore and that will be a sleeper transition that you experienced.

The key to understanding, and why you need to understand transitions. So, from my perspective, we know the transitions are going to cause some form of stress because they’re going to force you to have changes in your life that we are not, as human beings, as human species, we don’t find it fun guys, we just don’t find change fun and so we’re going to struggle with that in some way. Because we’re going to struggle with that, that’s going to start then impacting our entire wellness spectrum, so all of those elements of 8Wise and because of that, we are then putting ourselves at risk of developing mental health issues if that stress becomes uncontrollable and it leads to things like burnout, anxiety, depression, etc, etc.

What we need to do is we need to understand how the transitions are affecting us. So what we need to be able to do in order to manage the challenges and transitions that we’re experiencing, number one we need to be able to identify how it is triggering our stress levels. Meaning we need to understand what our stress levels are currently at. We then need to be able to understand how we are emotionally responding to those stress levels and to the transitions that we’re experiencing. We then need to be able to understand how those stress levels and emotional responses are then triggering our thinking patterns and from our thinking patterns, we then need to understand how it’s triggering our behavioural patterns.

When we know all of that, we now have a really good understanding as to how we are coping with the challenges and transitions. We then have a better understanding of where we might be sitting on the mental health continuum, whether we are thriving at the top there, or whether we are moving towards crisis. What we then need to do is implement strategies that help us to problem solve anything that is triggering our stress to the stages of overwhelm and this is when we have to start looking at implementing really effective self-care plans. The great news about that process is I’m going to be covering that process stage by stage in all of the episodes coming up over the next few weeks.

Next week we’re going to talk about stress levels, the week after we’re going to talk about emotional responses, then we’re going to be talking about thinking patterns, then behavioural patterns, and then we’re going to be going into a bit of detail with regards to self-care plans as well.

So I want to make sure that over the next few weeks that you are in a stage where you’ve got to learn about 8Wise, you understand what the process is, you understand what the core elements are, but you start to then understand “okay, this is happening in my life right now, this challenge, this transition, it is triggering my wellness spectrum in this way and that’s then impacting the way I’m thinking, how I’m feeling, my behaviours so if I am then going to manage that better, I am going to implement self-care strategy that boosts each of those eight core elements of wellness so that I can protect my mental health and get through this transition as safely and as effectively as possible”. And that my friends is what I call Living the 8Wise Way.

So that’s all about triggering transitions. What you need to know is a transition is basically anything that enforces major change in the way we currently live our life. There are four different types of transitions. All of them will have an impact on us. Some more negative than others. Some are more stressful than others. All of them can be managed as long as we understand how we, as an individual, responds to them and that then links into our overall meaning of life. How we respond to them helps us survive as an individual and it also helps us learn so we can pass that information onto the next generation so they can manage their transitions and pass it on and pass it on to help us as a species evolve.

So that is where we are at with triggering transitions. I hope you have found that useful. Thank you for listening. If you are enjoying the podcast, then definitely please get in touch and let me know. If you have any questions or any queries about anything whatsoever, then please, please feel free to contact me. You can contact me by email which is [email protected] and I will put that email address in the link below and I’ll put some other bits and pieces in the link below where you might be able to send me a voice note as well. But feel free if you’ve got any questions, any queries about things that might be happening in your life, any transitions that you might be experiencing, or if you just want a little bit of support with something, then please do just get in contact, send me an email, leave a voice note, and I will do my very best to give you the information that you need so it can help you move forward with it.

On top of that, if you want to, you are more than welcome to join the Facebook group which is called The 8Wise Wellness Café and the reason I’ve called it The 8WiseWellness Café  is because it’s just a place where like-minded people can come together, they can sit, they can chat, they can chill out and they can discuss wellness, wellbeing, the transitions in their own lives, they can get some support from each other and that’s where I’m going to be sharing information with regards to 8Wise tools, tips, all of that kind of stuff. So, if you’re choosing to Live the 8Wise Way that becomes the hub of everything that you need. Starting on 5th September in that group we have got our 8Wise Wellness Challenge, which is daily tasks for you to do for 30 days that will help balance and improve all eight of those wellness elements so that you can actually start having better mental health, better wellbeing, a healthier, happier mind, and most importantly, a better quality of life.

Now I mentioned at the beginning about the book. If you haven’t got a copy of any of the books and you would like copies of the books, then again, you can contact me directly, you can go directly to our website which is www.8wise.co.uk and you’ll find the bookstore in there and you can access all the books from there. But if you prefer using all of the other guys as well then feel free, you can go to Amazon, go to Waterstones, pretty much anywhere. Theres about 39,000 bookstores across the globe that you can order the books from and the books are 8Wise Ways to a Healthier, Happier Mind, which is kind of the mental health guide for the modern world. There is the 12-week journal so if you’re wanting to just focus on a short, sharp goal, then you can use the journal to help you achieve that. If you are looking to commit a bit more and go a bit more in depth with it, then you can get the 12-month planner. If you just want some short little titbits with regards to understanding what little things that you could do daily to improve your overall wellness and wellbeing, then there’s also the Pocketbook of Wellness that you can access as well.

If you are liking the podcast, please, I would really appreciate it if you liked it, if you follow it, if you subscribe to it, if you share it, if you talk about it. Do whatever you can, it would be great. This is all about helping people to improve their lives and there’s a lot of people out there who suffer in silence and just maybe, maybe this podcast can help a few of those, but that can only happen if people do, as I said, they do the usuals of likes and follows and subscribes, etc, etc.

If this is your first episode, thank you so much. I hope you’ve enjoyed it. I hope you’ve got what you want from it. Please go back to the beginning, go to episode one and work through and get a really, really good understanding of 8Wise so you can get the most out of it and benefit from it in any way you possibly can.

I will be back for our next episode where we will be talking about stress and I’ll be going through some tools and techniques with you on how to identify what your stress levels actually are, the practical elements to everything so that you are then able to go “okay, this is what my life transition is right now, this is how it’s impacting me and this is what I need to do to make sure I’m looking after myself better”. So make sure you tune in with me for then.

Thank you for joining me on this episode 13, this was triggering transitions. My name is Kim Rutherford, psychotherapist, author and podcast host as well and I look forward to chatting with you again at our next episode. Until then take care for now. Bye.

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The ‘Sleeved Psychotherapist’, Co-founder of CFBS and Weight Wise Bariatric online support group. Kim is also a Trainer, Author and creator of 8Wise™️: the blue print for optimal mental health and wellbeing and a bariatric patient since in 2021.