herewesayf&@#k!!!

Be sure to Breathe

The past few weeks have been an absolute shit show for me. The amount of stress, stressor, obligations, have too and tasks to check off of my too do list seemed like a never ending stream of shit.

I had finals, evaluations , and end of term bullshit for school. I had treatment plans, and assessments that were overdue for my field. Personally I had my daughter’s impending high school graduation and almost an entire month of “lasts” as she prepared to leave high school.

I had the unique position of wanting to be done, stressing every step to get myself over the finish line and wanting desperately to be present and enjoy the moment. Which was really hard for me, because I’ve always struggled to slow down when something big is looming.

It never mattered if it was good or bad, it just needed to be big. Big was enough of a requirement for me to want it to be over. I want to rush up the side of the mountain just to say I did it and it was over. This struggle is made harder by wanting 2 things to be over desperately, but hoping to enjoy the moment for a third.

I had my good days, tense days and the I wanna crawl back into bed because everything that could go wrong did go wrong. The days were technology actively fought me to help ensure my day wouldn’t work out right. I had tears in my eyes out of sheer frustration as I begged for something to get better or just stop.

I had to learn how to walk away, take the breathes, do the meditations and savor the moments I wanted to enjoy while working my way through the moments I needed to pass.

In the end I managed to every paler writing, assignments done, treatment plans done and paperwork finished days before my daughter’s graduation. I was successful at being present for every one if her “last times” within those walls. I could devote all my attention to the small details to ensure her celebrations were just like she pictured. She had her moments, her laughter, her tears ,her friends ,and family just how she wanted it .

……until next week.

When The Professor is Shit

It’s bound to happen at some point in your higher education. Sure, there will be professors that you just don’t like. Maybe your personalities clash, maybe you don’t like their style, maybe a single incident will just leave a bad taste in your mouth. It’s par for the course.

But the day will come when it’s not just a simple dislike and you just work through it anxious for the class to end and the class to be over. No, this will be a big deal. The day you have to log a formal complaint and make waves.

In grad school complaints aren’t made lightly and there’s always concern about the consequences. So what are the breaking points when it comes to deciding to file a complaint?

For me, there was a lot, as I’ve never logged a complaint at any point when I returned to school. I’ve had plenty that I didn’t like, be it their style or personality, and plenty of instances where I think they were wrong. But, that’s part of sharing any space, for any reason ,with any other human beings. It’s an assumed experience and so is learning how to handle it on your own.

But no, this was a professor that made class a complete waste of time (and when you’re paying around 4 grand for that class) wasting time matters. She was 5-15 minutes late to class every week and ran over the end time by about 15 minutes. She didn’t teach the work in the syllabus review the work, discuss concepts ,answer questions or explain assignments. She was also exceptionally rude, if she didn’t like your answer or even the direction of your answer you’d get an eye roll, sigh, or being cut off and moving on to the next person.

But ,my moment came when there was less than 2 weeks left to the class and not a single grade had been issued nor had any of the work been covered that was needed to write the 15 page final paper due in less than 14 days.

So I did the thing I didn’t want to do and bought all the documentation and complaints to the leadership if the departments and program…..and now I wait.

…..until next week

Close to Home

The moment all clinicians know will happen before they set foot in the field is waited on with baited breathe. It doesn’t matter what type of therapist you are counselor, clinician , or psychiatrist, is all irrelevant. The moment will come when your door opens and you are slapped in the face with familiarity.

They could remind you of a long lost friend, old flame, family member or an old vilian. It doesn’t really matter who they remind you of, the point is they do and it can significantly impact how you treat them.

The truth is every clinician will encounter a client, multiple clients, who remind them of someone they knew or know. That connection can be in a positive or a negative way, but is almost always discussed in it’s negative context. But, it’s the positive dynamic that should be mentioned more. So today I want to discuss my incredibly positive instance of transferece.

Transferece & counter transference mean the same thing, projecting your feelings of someone else onto a person. Transference happens when it is a client’s feelings & counter transference is when it’s the therapists feelings. Both are natural and will happen often. It’s self-awareness of the therapist that’s needed to make sure it stays a positive or natural aspect.

The therapist would keep and maintain established and professional boundaries to reinforce that they are the client and clinician. But the feelings generated can be used to foster empathy and see people as humans outside of their role.

The other day I met with a new client for the first time. She had already had all of her assessments, intake and a starting diagnosis and all I had to do was meet for the individual psychotherapy. While I prepared myself to begin to establish a theraputic alliance by establishing rapport ,empathy and trust, I was unprepared to be greeted by my 15 year old self in the waiting room.

While circumstances and situations were different this client had my exact attitude, perspective, personality traits and priorities of my former self. The only difference was the technology, wardrobe and slang of a generation. And with my of my teenage fads making a comeback she didn’t even look drastically different than my teenage self.

The benefit of this connection was that the process of connecting with the client, establishing rapport, making them feel seen, understood and validated was sped up. Because when someone came relate to or understand where your coming from, when they get what your saying Because of any shared connection…it shows.

You can’t fake guinuine or authenticity and when it is felt or seen it can be powerful.

……until next week.

Resets

If you have any experience in this field you’re probably well acquainted with the concept of self-care. In this field it’s as critical theory, technique and practice. Yes, you work with people, yes it can be an emotionally demanding job, yes burnout is possible for everyone….but as therapists we experience second-hand trauma often.

For all those reasons self-care and mental resets are critical for us to effectively take care of ourselves and our clients. It’s also important to know to utilize self-care constantly, if you wait until you feel burnt out or overwhelmed it’s probably too late to be effective.

Some instances may require bringing in the big guns that elevate your routine, but that routine should be well established by the time you start seeing clients.

So, what does self care look like?

….for starters it’s vastly different from it’s depection in the media. It is not saying yes to everything, lavish luxury and blowing your money on off limits expenses. It’s different for everyone, and can ebb and flow as we move through our day. Self-care is based on how to be your best and soothe your own soul while balancing your mental peace.

Universally self-care should involve some basic physical love for us all. It should look like making sure you are rested, fed and have time for a shower. It should involve making a keeping doctors appointments and taking care of your own physical health.

The rest is best designed around our personal preferences, hobbies and taste. Personally I enjoy a regular routine of yoga and using this space as a way to journal about my experiences in the field. I live to garden during the season and bake during the winter. I also rely on a steady stream of entertainment such as books, movies, shows and music to help as an outlet for any brewing emotions. I also rely on a weekly reset every weekend. Where 1 day is devoted to chores, upkeep and errands and the next day devoted entirely to me. Sometimes I meet friends for brunch, go on an adventure with my partner or binge on some entertainment and eat brownies for dinner.

While self-care isn’t exclusively blowing your money or anything and everything you can imagine it’s really important to find a way to incorporate treating yourself too. Whether it entails treating yourself to a massage, jewelry, trip or any upgrade find a way to reward yourself for all if your hard work.

……..until next week.

Why I hate doing an intake

Intakes are par for the course and by the time you begin working in the theraputic process you should be very comfortable with it. But, some of us hate the process

For those unfamiliar, a psychiatric assessment and intake are related but distinctly different processes in the field.

As discussed last week, an assessment is a detailed evaluation of a person’s mental health. This includes their symptoms, behavior and mental functioning. It involves a thorough review of their history, observing their behaviors and adminstrating of standard assessment tools based on the information provided. These tools take the form of questionnaires and rating scales that relate to specific subjects. Such as trauma, depression, alcohol, anxiety and anger. The final aim being to diagnose mental health conditions, underlying issues, identify strengths and create a treatment plan.

An intake is the initial process of gathering information about the individual seeking services. It involves
Collecting basic information such as demographic data, medical history, family history, presenting symptoms and their reasons for seeking treatment. The aim of this is to determine and identify their needs, prioritize service and assign to an appropriate provider.

The intake always comes first and is far less detailed than the assessment. It is the assessment that establishes a diagnosis and treatment plan.

….so why do I hate doing them?

For starters I hate the administrative aspect of it. The paperwork, documentation and data entry. It’s a time consuming process that takes away from the more direct care of working with clients. It’s repetitive and the basic questions often don’t allow for a more indepth exploration of where the clients at. They are also usually rushed ,with very limited time provided.

This time limit also makes any empathetic response feel superficial as it’s difficult to establish a meaningful connection with who could be your own future client (depending on how yout agency handles assessments). Which can be especially difficult for clinician and client as they may be re-traumatized by sharing older traumatic or distressing stories. Such exposure to secondhand trauma can be emotionally taxing for providers and lead to burnout.

And perhaps the biggest factor, at least in my opinion is the formulatic nature of the process makes it so difficult to add any flexibility or creativity to it. Which may seem like a selfish desire to put one’s on approach or style to the interaction. But, it is that signature style that generate genuine connection and empathy and helps a client determine if your approach works for them or not.

…..until next week

Assessments

….ahh, assessments the bane of existence to clinicians and client alike. They are tedious, time consuming where at best the questions feel irrelevant and repetitive and at worst invasive and uncomfortable. The only thing that’s worse than an assessment is having any answer raise the flag for another one.

It seems there’s no shortages of assessments to examine when a new patient needs services. And why exactly do we need to do all these assessments?

Because they help. They help discover mitigating factors, skills, obstacles, trauma,symptoms, substance use, maladaptive behavior, coping skills, stressor and supports among other things. All of which combine to help us make a diagnosis and create a treatment plan.

Everyone thinks the biggest problem with an assessment is asking the uncomfortable questions or keeping the client from getting annoyed, frustrated, angry or shutting down. But, I think it’s the lying.

Not every client lies, but most of them do…at some point at least. It’s not that they don’t trust you, or that they’re trying to be difficult, or that they don’t want help. There’s just so much guilt, shame and stigma attached to mental health, addiction and so many other aspects if life. Will the number of sexual partners, drinks on the weekend, or any other secrets kept be the thing that they’re judged for?

I used to think assessments would be more truthful when it involved children, because there were multiple sources. Clearly gaps and inconsistencies would be sorted by having multiple narrators…alas no. Parents, grandparents fear judgement just as badly as an individual. Families harbor secrets ,trauma and dysfunction like anyone else.

So we take what we learn and we make the best of it. We try to paint the clearest picture we can as we create a workable game plan to help this person heal, function, thrive and learn.

15 year-old Female just released from inpatient 30 days with a history of running away and self harm. She has a family history of depression, substance use disorder and anxiety.

Client reports feelings of depression, anxiety, anger, sexualized behavior and trouble regulating her emotions. She reports vaping, marijuana use, occasional use of hallucinogenic, and using pain pills such as vicodin & codeine.

She lives with her Father, Grandmother & Grandfather, as her grandfather is currently in hospice care. Dad was awarded custody and there is no relationship with biological mother. There is a history of severe neglect and abuse with her mother, but client is unwilling to give further details.

Client has a history of skipping meals, binging, but no reports of purging. Reports enjoying soccer, reading and baking. No reported suicidal ideation, plans to commit suicide or previous attempts. No instances of violence or threats of violence to others.

While an initial diagnosis of depressive disorder single episode, unspecified anxiety ,unspecified trauma and adjustment disorder there is also a risk of future substance use disorders.

Which leads to the agenda of using DBT and TFCBT to treat and to create a treatment plan next session, during part 2 of the assessment.

……until next week

At the beginning….the Sequel

The first week went off without a hitch, but I’m pretty sure it’s because this is my second go round. You see last year was what is deemed my “generalist year”. A time when you dip your toe into the field and are still taking the course you are required to take. First time field experience can be anything from answering calls, shadowing a supervisor, caseworking and paperwork. I lucked out and was assigned to an amazing spot (anonymity kills me to not give my supervisor the recognition she deserves)

I was placed with a woman who had 2 strong beliefs. 1) The best way to learn was to do and 2) it’s disrespectful to sit in on someone’s session.

So, despite my fear ,nerves and the desire for someone more qualified to do it I was asssigned my own client list and began individual psychotherapy sessions. Now, don’t get it wrong, my supervisor was 3 doors down and all I had to do was call if I needed anything at all. I checked in with her after every session for evey client. Not only did we review what happened but we discussed it from every angle and considering every imaginable aspect. Needless to say, the experience was priceless & I learned more than I expected and sometimes I think more than my peers.

Now I find myself at the start of my “specialist year”. The place everyone envisions when they go back to school to so this work. My classes are my choosing for how I want to specialize my practice and fieldwork is guaranteed clincal work.

So, where do I stand on starting for my finish line?

The answer is two-fold as my focus is on trauma & addiction while specializing in family therapy. The result has been field placement working with children and families as I begin studies in addiction, CBT & suicide prevention.

That’s where I stand this week. Starting my classes this week and doing all the agency training for my new clinician spot in field. Intitial classes will be the ho hum of upcoming assignments, readings, introductions and formalities. Then I’ll have to get through the who’s who and the how’s how of policy and paperwork I’ll have clients assigned and appointments made.

……until next week

Finding my Bearings

It’s been quite awhile since I’ve taken the time to write for enjoyment, and there’s alot of reasons for that. With the biggest being my return to graduate school after an impassioned decision to change my life and reignite dreams long set aside.

I had a list of things I had wanted to do and didn’t, for one reason or another, and becoming a therapist was one of them. With the support and urging of my first born I decided to let go of my own hang ups about being too old ,looking silly and everything else our ego’s tell us to hold us back and enrolled in school.

So, here I am well past 40 and establishing my 3rd life with just 2 terms and 500 hours of clinical work left before I can sit for my exam to become a liscenced clinician in the state. It’s here that I decided to pick up my blog again.

For what purpose exactly I can’t answer. Maybe I miss writing for myself, because churning out paper after paper week after week has certainly sucked away my love of the written word. Maybe it’s so I can feel like I’ve contributed in some degree to stop the flow of misinformation or disinformation about mental health that’s a click away. Or maybe it’s just to share my experiences somewhere and with someone to make them feel real.

Who knows ?

Either way I will be sharing each week about something going on in a class or my sessions (obviously no ethical breaches as clients will be completely unrecognizable with their diagnosis and/or treatment being the focus) as I navigate finishing the work, graduating and becoming official.

Maybe nobody will show up to read more and this will never be more than a reflection on my journey known only to me….but maybe someone else reads along and learns something interesting. Be it about themselves, mental health or anything else.

……until next week.