understanding (n.)

I am having to learn how to be a DMHP all over again.  And it is exhausting.  (read: the person who acts as an arm of the superior court to make decisions as to involuntarily detaining patients to psychiatric beds.)

A week before my wedding in 2012,  literally the week before my wedding, I was at a DMHP week long training in the city.  And then I went back to the community in which I was working, and the coursework did not transfer over to any practical skills.  O, how I just dreaded, dreaded, dreaded crisis work in the previous community.

For propriety's sake (and o, my word, is it difficult to be in a place where I observe any propriety), I'll refrain from going into why they skills did not transfer over.  That county just did things that county's way.

So now, while I am building up my child and family caseload at the New Clinic, I am being trained again in DMHP work, because I will be expected to take crisis shifts 3 to 4 nights a month.  There is always a sliver of worry that pierces my spine when the crisis calls come - hard and sharp and automatic.

I am slowly learning that the New Clinic's way of doing crisis is so different from the Old Clinic (and we're talking the job before my last one, folks.  Two jobs ago) that it shouldn't even have the same name.  I'm learning.  Learning how to trust my clinical skills.  Learning to trust that help will actually be there.  Learning that I *can* make sound clinical decisions that serve my patients' best interests.

Slowly learning that crisis calls don't have to be spears of fear.

I'm grateful for that.  It's a slow gratefulness, but gratefulness none the less.

The head crisis worker at the New Clinic has been training me carefully.  He is a quiet, gentle, seasoned veteran, and he continually asks me quietly, "What do you make of this?"  "What do you think about (something)?" "What could this be from?"  And then when I hesitate or apologize for thoughts he quietly says, "I like your line of thinking" or "Go on with that thought a little further."

And this is where we get all Mufasa lifting Simba to the sun.

My MIL was a clinical psychologist in the area for years.  Head of mental health, retired now for a bit.  Next state over, but the same geographical region as where we all live now.  The Head Crisis Worker at the New Agency actually worked under my MIL for a long time.  (That's how it goes in small towns.)  Today Head Crisis Worker and I responded to a particularly sticky crisis call at the ICU.

As he was writing his final documentation (and we had been there for hours, my stomach grumbling and my head swimming from information), he started chuckling, looked up at me over his glasses and said,  "I find it ironic that as I'm writing this, I'm very much remembering things I learned from (my MIL)."

It's all in the family, I guess.

Look, folks.  All I really want to do is get back to providing child and family therapy.  But if this is what has to happen as part of this package deal, as long as it looks like this and has this type of support, and as long as I'm surrounded by clinicians who are in this for the patient's best interest, I think I can stick this out.  Being an Every Person with Other Duties As Assigned is part of working rural community outpatient health.  I wasn't prepared for that at first.  I think I'm getting closer to that point.

July 12, 2014 ~ Captain's exploration log.

This new clinic is a foreign, bewildering place of hot tea, water features and piped in music.  The inhabitants claim to be rural community outpatient mental health, but I continue to look for signs of proof to this claim.  Upon arrival, the presiding therapists came out of their offices and while I presumed their first, most pressing question for me would be "When are you going to take your first crisis shift?," they most confusedly instead asked me my name.  Additional observation needed; we don't appear to be speaking the same language.


Maybe it's because this clinic is actually in the town with the PAC12 University.  Maybe it's because of some vision somebody had ages ago to buck all stereotypes of rural community outpatient mental health.  Maybe I don't know why it is, but this workplace is different.

~ We have a prescriber who's there several days a week.  A prescriber!
~ We have several licensed social workers, licensed mental health counselors and clinical psychologists.
They like each other. (??)
~ The executive director attends all clinical meetings.  Quietly.  Just so he can "really know what you guys are dealing with on a daily basis."
~ Despite the fact that I am already qualified to be a DMHP in this state (read: I can involuntarily detain people to psych beds), nobody has asked me when I'm going to start taking crisis shifts.  They like doing it.  There's no rush to push it off on someone else.
~ There are *several* case managers.
~ I am actually being *trained* to do crisis on call, and with that, am receiving a ton of training on SPMI (never had that before, folks.)
~ I called my first clients and when I asked where I needed to document that, I received a concerned, but caring, look, and my co-worker stated, "Oh, you don't.  It's fine.  People trust you here."
~ We gave a "great" relationship with local law enforcement.  (? What ?)
~ The Friday Therapists (the few of us who work Fridays) asked me to lunch the first week.
~ HR actually sat down with me the first day to explain benefits, gave me a key and asked me several times if I had any questions.

Look.  I'm not saying it's perfect.  I'm not saying things aren't going to bother the crap out of me at points or that I'm going to love everything.  I'm not delusional.

What I am saying is that this clinic feels more like the clinic I left in my native Portland.  I'm saying that I'm having cross disciplinary meetings.  I'm saying that we're speaking about heteronormative and gender normative language.  I'm saying that somebody said "prodromal" this week and I literally have not used that word in two years, despite working in mental health.

I *am* saying that people are happy at this clinic.  People have worked at this clinic for 20+ years and nearly every one of the old timers has said, "Fresh eyes!  Ask questions!  Let's better this process!"  I am saying that, after two years of rural driving, the clinic is 7 minutes from my house.  I am saying that I worked 40 hours (as opposed to 55 or 60) this week.

I *am* wondering if this is going to be the switch Shoes and I needed to be able to stay in this area for a few more years.    I am cautious, but I am hopeful.

And by that, I mean, oh, this poor me.

(I may not even pretend to try to suck it up in this one, guys.  I'm not looking for your pity, per se, but a well placed social worker "amen," "hallelujah," or "preach it, sister"will not be rebuffed.)

This blog has seen the evolution of my life for the past nine years - from the days I worked in juvenile justice and was married to a Different Guy,  to the decomposition of that marriage, to deciding to go to grad school, to meeting and marrying Shoes, etc, etc, etc.

Etcetera.  Etcetera.  Etcetera.

I have not used this blog to document my first two years after graduate school, however.  Two years?  How did that happen?  Living and working in the rural, RURAL, Inland NW has been an experience unlike any other.  I have not yet found my niche.  I have job hopped twice now.  That's not me.  I thrive on consistency and routine in my own life.  This just isn't me.

You might remember that I left community outpatient mental health, for reasons I won't speak about, to join a new agency, providing in home family therapy in an effort to prevent placement of children into the foster care system.   That was very, very good work that I loved whole heartedly.  It turns out I didn't, love, however, being on call 24/7 (literally going months being tied to my work cell phone), working almost every weekend, working 60 hour weeks, and putting thousands and thousands of miles on my car driving to the most remote locations you can imagine.  Places without electricity.  Places without running water.  Places where I fed goats and stacked firewood.

(That last one actually wasn't that bad.  I like farm chores.)

And it didn't work.  It didn't work with my family.  It caused stress within my family.  It caused mini meltdowns.  I have missed out on holiday functions and birthday dinners and quiet moments with my spouse.  Most days I have managed to take care of basic hygiene functions, but nothing really beyond shower, deodorant and combing my hair.

(Uh, ok, whatever.  I didn't always comb my hair.  But it was washed.  Most days.)

It just reached this critical stage, you know?  One of my best friends from graduate school finally told me I was being unethical.  I wasn't taking care of myself, I was distant from my family, and oh, this next one was ouchy, but it was entirely true:  he stated that because I was so burnt out, I wasn't giving my clients the best care I could because there was nothing else to give.

Put your own oxygen mask on first, folks.

So I did.  Ok, that's a lie.  It wasn't only on my own accord that I reached up for the magical oxygen mask and it's not like those things are just hanging down magically everywhere....  A therapist friend of mine who works at a local clinic contacted me and said they had an opening and were willing to consider hiring an unlicensed therapist (I am 2/3 of the way done.)  I applied.  And interviewed.  And 45 minutes after the interview, they called and offered me the job.

So I'm transitioning again.

My last day with the last agency was yesterday; I start the new job on 7/7 as a children's mental health counselor at the new clinic.   That is closed on the weekends and major holidays.  That comes with a pay raise.  That comes with agency sponsored CEUs (no more paying for my own!).    I'm not on call all the time.  I have looked for my dumb pink work cell phone about 50,000 times today, panicked when it's not right there because HOW WILL I HEAR IT???  Only, that part is done.

 Today I SHOWERED, and COMBED my hair, and glory be, I even put product in it and styled it.  What.  I'm *bringing* the personal hygiene now.  I took my car in to necessary repairs.  Scheduled Rosie's grooming appointment.  Normally I would be catching up on housework, but, as it happened, one of my last families struggled with organizational challenges and when that happens, my own house gleams.

I'm re-entering the land of the living.  And I have goals.  We planted a vegetable garden.  I would like to see it live.  Shoes and I are planning some big changes in our family.  I want to write the short story I've been meaning to.  One of my parents is having major, major health challenges.  All of these things will need attending to.

So I haven't really been blogging the past two years.  It is what it is.  Now I get to pick it up again and continue.  My hope is to reconnect with my old blogging network (that community has changed significantly, though, so unsure what that will look like) and make new blogging connections.

And be a normal human being (whatever that means.)  I am also looking forward to that.