herewesayf&@#k!!!

The fucking finish line

As the week comes to a close all I can think is there’s nothing left, I’m running on fumes and sheer will and I feel like I may not make it while at the same time I know it’s not possible. With a week left to Tokyo fingertips are grazing the fucking finish line.

While there’s still 2 weeks till graduation, a month left until my conferral date, 3 months minimum until I can sit for the states liscensing exam and who knows when until I find a hand to God, here’s your office, clients and salaried position…I have 1 week left of work to finish the program.

I have 1 class left, 2 final papers , 8 more chapters and 3 days or 24 hours left to work in the field before I will graduate.

And like everyone else who reaches the end of a long journey and finishes their marathon I intend to savor the completion, reboot my batteries and recharge my spirits before slugging off again to hopefully find the opportunity or job of my lifetime.

Some things this experience has taught me is that I work great with teenagers, enjoy my littlest of patients and am quite skilled at play therapy. While some parents test my limits and my abilities when I have to rely on “gentle parenting techniques ” for Mom and Dad, I do enjoy working with families and my family work has been incredibly rewarding. I’ve also learned that I have a natural talent working with children’s experiencing trauma, most particularly sexual assault and abuse survivors. While the work can be challenging and daunting it has proven to be immensely rewarding and nothing compares to bearing witness to someone go from viewing themselves as victim to survivor as they reclaim their power and their voice. Knowing I played a role in helping them on that journey is one I simply can’t put the proper value on

So as I transition from winding down and wrapping things up I will also begin to expand horizons ,look out for new opportunities and continue to grow into the therapist I’m meant to be.

…until next week

The Holiday Fucking Experience

Personal disclaimer, I grew up poor, not poor we don’t take more than 1 vacation, but bo vacation. Not only did we not take vacations, but we ate our cereal with a fork and shared bath water poor.

Despite this my Mom owned Christmas. She managed to to create the illusion of all our wishes coming true that she shoulda worked with fucking Copperfield, Blane or Angle. She managed to turn $ store crap into something cute and thrift a treasure outta thin air.

It was years, and I mean in my 30’s years before I realized how little we had and littler that I got for the holidays. But despite this I was privileged, I was loved, celebrated and there were many years thrown in where my Christmas was Grand.

My adult years, motherhood, wifedom and all the other frills of being the head bitch in charge for the holidays have seen me taking my mothers crown and surpassing her. She would love the Christmases I pull off. The decorations, the cutting of our tree, the cards (I’m 1 of 8 remaining humans that send a card), the baking, the movies, carols and traditions are all things my Mom would enjoy. I’m a miracle worker that makes Christmas magic every mutherfucking year and grant every want of my family and sprinkle some extra generosity to everyone I can.

This polar express of dreams starts the day before Thanksgiving when I prep and cook for the next day. After all the dishes are done, family’s left ,house is cleaned and shower has been had…without fail I sit and enjoy a Christmas movie and turkey sandwich while I finish my holiday shopping. The weekend is filled with cutting down the tree, decorating the house, filling out cards, Christmas movies and Holiday Baking. Every weekend from then till Christmas is spent doing something for the holidays with someone. Until the Christmas Eve dinner and the party for family that I host between Christmas and New Years.

But the thing is, as I switch into Holiday gear after fattening my ass up since Thursday, this work has taught me how important it is to do 3 things during the holidays

1 ) It’s critical to hold tight to your family, your traditions and the experiences that bring you joy. While everyone should do that with everything they can , in the field it’s critical to allow the supports in your life to support you. The vicarious trauma experienced in clinical work is enough to burn anyone out.

2 ) It’s important to prioritize the aspects that bring you joy, but to recognize your limitations and not attempt, try or hope for perfection. You certainly don’t need to add another stressor or unrealistic expectation to your fucking load.

3 ) As much as you may love your family, friends, traditions or experiences…no matter what they are..if the work teaches us anything always remember your experience is not THE experience. Don’t assume or take for granted you know a single godddam thing about anyone’s reality and no matter how similar it may be you don’t know what it feels like to be someone else or how their experience feels.

With that I hope no matter where, how, or what you celebrate or skip ..you are happy, supported and loved.

…till next week

Fucking Grief

Grief is the loss of anything precious to us, this can include our home, health, or relationships. There are different types of grief that include anticipatory grief, complicated grief ,Disenfranchised grief and ambitious loss.

Everyone seems to know Kubler-Ross’s Theories of Grief stage models that include denial, anger,bargaining, depression and acceptance. But there are also the 6 R’s, the 4 tasks of mourning and the duel process model.

The six R’s include recognizing the loss, react to separation, recollect or re-experience the deceased or the relationship, relinquish old attachments to the dead, readjust to move adaptively into a new world and to reinvest.

The four tasks of mourning include accepting the reality of loss,working through the pain of grief,adjusting to life without the deceased and maintaining a connection with the dead while moving on.

Lastly the dual process model is made up of two parts ; loss orientation and restoration orientation. Loss orientation includes grief work, intrusion of grief ,denial of restoration and related challenges. Restoration orientation includes doing a new thing, distraction from grief and new roles or relationships. If either of these aspects are not met problematic grief can result.

Problematic or complicated grief occur when normal grief (grief but can manage/sustain life involvement ) is no longer managed and these feelings opossum remain significant and persistent.

Factors affecting adjustment to loss include the nature of the relationship (dependent, ambivalent,conflictual ,abusive) or the nature of death (violent,suddent,prolonged suffering)

Risk factors for complicated grief include it being either a spouse or parent (usually the Mother), the type of attachment and individual has (anxious/avoident/insecure), low social support, if you found, saw or had to identify the body, abusive relationship with the dead, history of abuse or neglect and if the death was violent. The greater number of risk factors the higher the chance of complicated grief.

Despite all of these different facts about grief there are some universally important facts to remember. They include, there is no wrong way to grieve, if you feel it then it is a normal fucking feeling, and everything you need and however much time you need are the right feelings and amount of time, and people will say some of the dumbest, insensitive and just wrong shit to you…don’t let them invalidate or infringe or your grief.

…..until next week

I’m tapped out

Not gonna lie the overwhelming shots torment coming from a never ending parade of stupid has been enough to make school work, clinic work, real work and family work almost unmanageable.

I’m exhausted, I’m numb, I’m scared and I’m trying to stay whole so I can stay 100% present for every moment with my clients.

Stay safe, stay happy, stay kind and do things that nurture you body,mind, heart & spirit while feeding your soul.

…till next week

All The Fucking Questions

I sit here with 8 weeks left till graduation, 8 weeks left in my field work and 8 weeks to get a handle on all the fucking questions.

I wish my questions were as simple as will I pass and where should I focus to ensure that, and not to brag, but that’s nowhere close to a concern. I’ve maintained A’s since I went back to school and crossing the finish line has never been a maybe.

Instead I have a myriad of questions needling the tiniest of details. They include the ever popular how to best terminate my theraputic relationships ? When can I take the licensing exam? Do I have everything I need to take the exam? What paperwork should be done for graduation? Do I go to the ceremony? When do I start looking for job? Is it a bad sign if no jobs have been offered? Are the offered jobs scams or spam?

These fucking questions needle me persistently and at the worst times. Worst of all they don’t annoy me, they make me so annoyed at myself that I wanna punch myself in the face.

But I fear I am creating these mindless ,predatory questions to distract myself from the big ones….the ones I’m not sure I can answer ,or worse, want to answer.

What happens next? Where do I want to work? What kind of work do I even want to do? Do I work in clinical, policy,administration or research? Then I must decide what population do I want to work with or for? Perhaps the most daunting of questions is where am I best suited? Sure I love ,absolutely love,working with children & families as a clinician…but am I ill suited for it? Will I cause harm? Or will I do the research that some extremist politician will 1 day cite as a twisted justification to cause harm for political gain?

When I went back to school my idea was so concrete and finite. I wanted to create policy and work for the LGBTQ+ community…..and while I still want to I am not sure how it fits into my new goal. Find what work feeds my soul, but that I am the best suited for and the best at that will make lives better.

The road to witch seems more uncertain.

….until next week.

Family Fucking Therapy

There are so many ways, angles and subtopics when it comes to family therapy that it can be difficult to decide what the fuck to even talk about.

Do we start off trying to define families and all of its aspects, do we discuss terminology like homeostasis or do we consider how to decide when it is warranted or successful? There’s so fucking much

For me the most pressing part of family therapy is to ouline how it is different from individual therapy and when it is the more beneficial option.

While there’s the obvious difference in numbers there is also a different in structure of the session and the goal. Individual therapy is about meeting the client where they are, determining their strengths, weaknesses and how their perspective and personality impacts how the approach ,see and deal with various issues. It’s about helping the client create, address and achieve goals they determine while maintaining balance and personal autonomy.

Family therapy on the other hand is about learning and sharing the roles family members take on, how they interact, defining subsystem and working together so they can learn how to communicate better, achieve cohesion and address specific issues.

Another big fucking difference is the role of the therapist. In individual therapy the main focus is on supporting the individual. That may include providing psychoeducation, build self esteem, take on personal responsibilities, etc.

For family therapy the therapist is a facilitators and mediator who can use various skills, such as observation and psychoeducation to help guide the family in navigating, understanding and cha aging their dynamics. It’s also critical that the therapist don’t take sides, connect with each member and be willing and able to modify ot change their modality to address the individual needs of the family members. Always remembering that the family system is the client

While the benefits of family therapy can include improved communication, conflict resolution,creating a supportive environment and enhance the relationships of the members how do you determine when family therapy is the right treatment ?

The best time to choose Family Therapy include when you’re facing family conflicts and communication issues, parenting or child behavioral issues, blended families or stepfamily dynamics need to be addressed or worked on, substance abuse or addiction issues within the family,and major life transitions such as divorce or moving.

Individual therapy on the other hand is best explored when someone wants to address mental health concerns such as anxiety, depression, trauma or past traumatic experiences, self esteem or confidence issues, managing unhealthy behaviors, decision making ,coping with issues or life changes and personal growth ot goals.

Like all theraputic interventions family therapy is nothing to be ashamed or embarrassed by and it can be a great way to help navigate situations with so many different perspectives and individuals making up a family unit.

….until next week

When they fucking leave

I know some people will talk about the business of mental health and this concept that you are never really “cured” so you’ll always need therapy on some level….keeping us all in business indefinitely.

I can see why the talk exists, but the truth is always a bit more complicated. The truth is two-fold, therapy is only as effective as the client allows it to be. If they don’t want to do the work, then the work won’t be done. If they don’t want to make the changes then the changes will never happen.

Another truth is that therapy may never really start or ever really end….fucking confused yet?

People come in and out of therapy over the course of their lives. Sometimes they’re earnest in the effort and put in the work, sometimes it’s a deep cleaning and sometimes a spring tune up. Sometimes they are dealing with a situation and sometimes they are working in themselves. And sometimes, sometimes they just aren’t feeling it and they leave .

You may have a detailed treatment plan, they may have outlined their goals ,expectations and what needs to happen for them to consider treatment a success. Despite any if this they decide to quit. You know this, you expect it…what you don’t expect is how viscerally you react to it.

I’m struggling with my own anger at my clients bailing…and it’s for lots of reasons. None of which include losing their money.

Maybe they were starting to get into it….and that can be uncomfortable at best and painful at worst. Maybe they were close to their first big breakthrough and you knew they deserved that change in perspective. Maybe someone close to them convinced them they didn’t need it anymore and you would have wished they weren’t influenced in their opinion. Maybe they were getting annoyed by some part of the process and they weren’t willing to keep going through the trial and error process.

But nothing is as shitty as when they give the fuck up. Not even on therapy, but themselves. They’ve lost hope that it’s worth it, that it will help or that they deserve happiness …or whatever they were hoping to achieve when they started.

I just wish someone had prepared me for my anger and my opinions when I have to sit back and watch my clients give up on themselves

…..until next week .

DB fucking T

DBT stands for Dialectical Behavior Therapy & it is a combination of CBT (cognitive-behavioral techniques), mindfulness and acceptance-based strategies. There are 4 modules of DBT, mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. These techniques help a motherfucker manage emotions ,tolerate stress and improve their relationships.

Some common mindfulness techniques include Mindful breathing,where the client can focus on the present,observe breathing and body sensations. A body scan helps the client notice physical sensations, and release tension. Walking meditations help the client notice every step and how they’re feeling as well focus on their surroundings.

Some common Distress Tolerance Techniques include TIP skills to help an individual Manage emotional intensity by using Temperature, Intensity and Pacing. For example they could take a cold shower, engage in vigorous exercise ,speed up or slow down their actions. Distraction techniques can cover a wide array of exercises, but all are designed to shift focus away from distressing thoughts. Radical acceptance is one that sounds easy, but it takes alot to get there. This is when the client can Acknowledge the reality of a situation and make peace with that, despite it being uncomfortable or painful.

Emotional regulation techniques include learning to identify emotions. This includes recognition of and labeling emotions. There’s a lot of focus on tuning in to physical sensations experienced during these emotions and what triggers them for the client. Which connects to the technique of understanding emotional triggers where the client learns to identify situations that lead up to intense emotions. Another technique js emotional opposite action ,this is where the client engages in actions opposite to the emotion. Such as doing something pleasurable when feeling negative feelings or mood.

Some interpersonal effectiveness techniques include Boundary setting, active listening (where the focus is on understanding what others say) and Assertiveness training. This involves a lot of “I” statements and practicing using them to express needs and boundaries.

There are other techniques and countless ways to implement them, but perhaps nothing is as critical as understanding what clients will be best suited for DBT and what techniques will best address them. For example DBT has proven to be effective across all demographics and for a slew of issues and diagnosis such as BPD, PTSD, ODD, self-harm and suicidality, anxiety,depression substance use and eating disorders.

……until next week

Cutting

I think it’s important to take the time to talk about self-harm and specifically the art of cutting.

If you’ve never witnessed, have knowledge or experienced the practice it’s easy to feel overwhelmed by the shock of it all. In fact those who are completely unaware of mistake it for a past suicide attempt. And while there is a definite link between suicidality and the act of cutting they are different.

While cutting can be used by people regardless of gender, race, age and social class it is overwhelming found among female. It is typically seen as begining around 12 -15 years of age and peaks in young adulthood.

The pathology of cutting also see it cuoccuring with other mental health disorders such as borderline personality disorder (BPD),depression,anxiety disorders,post traumatic stress disorder (PTSD)and eating disorders.

Common treatments include dialectical behavior therapy (DBT), which can help reduce frequency and severity. Cognitive Behavioral therapy (CBT) can help the client identify and challenge the negative thought patterns associated with the act. psychodynamic therapy will explore underlying emotional conflicts and relationships. Mindfulness-based interventions will help enhance emotional regulation and self-awareness. Medications can address more issues like depression and anxiety that are an underlying cause of the behavior.Family therapy can not only improve relationships and communication within the family,but it involves the family to help support the client. Group therapy will provide social support ,skills training and psychoeducation.

But, the biggest part that needs to be addressed and is rarely talked about is that cutting serves a purpose to those who do it. The act functions primarily as a coping skill and a way for individuals to help emotionally regulate themselves. It can also be seen as a form of self punishment and help with sensory-seeking impulses. Common triggers include stress, conflicts in relationships,being emotionally overwhelmed and processing trauma.

So far in the field I’ve noticed a direct link between cutting and sexual assault. So many of my young pre-teen and teen clients that engage in cutting share the trauma of some degree of sexual assault. The result for me has been the importance of creating the bond, earning the trust and establishing the rapport.

Critical to that is more than just a lack of judgement or generating empathy, its understanding that self-harm is a coping skill. Despite how scary and fucking overwhelming it can seem it is something that kept them safe and helped them survive. Which it makes it crucial to reflect that too them. To make them feel seen, validated and understood.

Because once you can understand what they get from it, feeling soothed or in control, than you can understand what they need to replacement the behavior and how to accomplish that transition.

…..until next week

Fucking up

Sometimes they aren’t no way to deny it, you just fucked up. It can be a hard pull to swallow and it comes in all shapes, sizes and costumes…but when you really fuck up, boy do you feel it on impact. What’s worse about those deep felt fuck ups is, that you never tried ,intended or meant to fuck it. They aren’t usually the result of carelessness either.

That’s what sucks the absolute most, my fuck up wasn’t the result of being lazy, half assery, stupidity or even blinding arrogance. Rather it was a slow burn of a fuck up where I considered, decided and methodically chose a path I believed I was correct with…only to see it cone crashing down when I saw where I made flawed decisions based on the wrong information. Is that arrogance? I’m not sure, but I can tell you nothing is more painful than realizing that each choice made individually would be just a simple mistake but together is a fuck up.

A fuck up where I did more than just look bad, I left the client hanging. A fact that in it’s worst case scenario would have been negligent, but I got lucky.

Where did I fuck up you ask?

Well I started my day meeting with my supervisor to review my sessions and paperwork. She stated my last session wasn’t my client but was meant to be a check in, but she explained it was being errored out and I didn’t have to touch or do anything. Now because there for late hours & you can get a late addition to your schedule with an intake or check jn I didn’t give it much mind. But as my shift ended I refreshed my schedule and saw it still wasn’t errored out and it was too late for me to get a last minute addition. So I thanked the God’s above and left 40 mins early.

Now my fuck up was easy to miss without explicit dialog, but I essentially misunderstood my supervisor. My session wasn’t being errored out, specific paperwork was. That was what I didn’t have to worry about. So the client waited for a clinician to check in on them while their therapist was out of town. Which, was in and of itself an easy fix. The receptionist could have explained it to them and clear it up with me when they arrived. But, that couldn’t happen with me out of the building.

This led to the panic of who would see them, where was I and why did I leave. Again, because I assumed it was a clerical error and I had no client I also assumed that because it was so late it was no big deal to tell my supervisor what happened the next day. Which again, given the reason behind my choice wouldn’t typically be a big deal. I have left early when my last client canceled without notifying my supervisor before. But, when you have a client there , staff looking for you and everyone unsure of what happened I can assure you it is a big fucking deal.

Because the worst part was this client was a high risk ,suicidal ,teenage girl. She was fresh out of her hospitalization and needed to check in about how she was doing, review her safety plan and just needed to rely on the people and system in place to help keep her safe. Instead she was told the clinician left and sent home bewildered ,angry and shocked.

I know everyone tells me that you have to fuck up at least a few times before your legit and fucking up is how we learn..but I never want to fuck up again where I’m not the person feeling the damage and consequences.

……until next week