understanding (n.)

Shoes does not understand my work schedule.  (I don't understand my work schedule either).  I've done all I can do in scheduling this summer - and somehow we scheduled out until the middle of September.

Amazing.  Summer slips away.
It's a sweet slipping, though.  We are so very much enjoying our life together.
Rosie is enjoying it, too.

But it's busy.  Yes.  And I've written everything down on our family calendar, which Shoes forgets to check. I've verbally repeated our summer schedule so many times I can tell you exactly what we're doing, without thinking, for the next 10 weekends.

What a talent.

Shoes and I were talking about the next two weeks, and he said, "Why can't I get your schedule down?  Why is it so confusing?"  And I said, "Because I work when my clients need me.  Some weekends, some evenings, some early mornings, and then maybe 4 days off."

Then Shoes asked what this next week was like for me and I said, "You know, normal.  This is a normal week."  And Shoes said,

"So you're going to work at 2 am on Monday and then you'll work to 7 pm and then go to work again at 8 pm and then you have to drive a client out to Tukwila  for a jumping jack contest and then you have to deliver a baby  and then you have to clean up dog feces and then you have to write a report that you have to present all formally to your team and then you have to create a feelings thermometer with a 6 year old and then you have like all week off."

That is sometimes how it feels.
By the way, I do not cover Tukwila, but Tukwila is very fun to say.
I do sometimes help clients clean up after pets.

I have never been to a jumping jack contest.
I wonder  if there is such a thing.

Two thumbs up for social work.
And summer.  Two thumbs up for summer.

And honestly, folks, that's just almost unheard of in many social services agencies.

It's pretty easy for the problems of the system and the clients to seep into social service agencies.  You might think an agency of therapists would be a super healthy, nurturing and empowering place to work.

Sometimes it is.  When I interned in NE Portland, I was blessed beyond measure to work with a group of therapists who had a code of honor that included things like:  I'm not going to listen to you complain about another therapist - go talk to that person; and; what do you need to take care of yourself right now?  go do it.  The administrative help in that agency walked around saying things like, I never want to work anywhere but here.  What can I do to help you today?

That takes commitment, folks.  It takes a good daily examining of what's going on inside you and to not get caught up in what some folks call low brain thinking.  And when it works, it is simply fabulous.

I also worked for an agency that was a lot like Survivor.  Only, we all suffered infections in the brain, the production crew and any chance of rational help deserted us, and there was no cash prize at the end. Things like this happened:  therapists covertly took unflattering pictures of other therapists in staff meetings and sent them to other therapists.

I just can't really even think about that job.  It was as if I fell into some hell version of Wonderland.

So now, I work at another healthy agency, where my supervisor says, What do you need from me today?  What can I do to help?  Where are your families at?  Now.  At this agency, we are all currently at risk of being furloughed, indefinitely, because the State hasn't passed a budget yet.  Children's administration and the Attorney General's office have all received layoff notices.  I won't know until Monday, 7/1/13, when I check my email, if I'm going to work that day or not.  Shoes is also at slight risk of being furloughed.

This doesn't sit well with my planning nature.  And the thought of both Shoes AND I going without work makes me queasy.

But I was sitting in this emergency staff meeting this week, and we were all receiving this news, the first words out of my coworkers mouths were, "I can't believe this.  Do they not know how this is going to impact vulnerable children?  What can we do to support our clients during this time if there is a government shut down?"  And today, during my group supervision and team business meeting, one of our agenda items read:

How are you challenging your own unhelpful self talk about the current uncertainty with the budget?

My first thought?  Honestly?  This is ridiculous.  It's not unhelpful self talk.  It's a stinking reality.  Both Shoes and I are going to lose our jobs and how are we going to make our mortgage payments and my student loans are due soon and ...

...oh.  Oh.  So THERE it is.  That's the little bugger I need to challenge.  There's the fear.  The lack of faithfulness.

Not easy.

Then again, 100% of the change I ask my clients for is also not easy.  And those of us in the field tend to believe (although probably not all of us) that we can only take our clients so far as we ourselves have gone.

This job is helping to change me.  Thank.  Goodness.

I have a lot of refining that needs to happen.

Last post: listening.

This post:  not listening.

I used to have a lady, whom I loved,  who did my hair.  She was truly a sweet, bubbly soul.  Optimistic.  Loving.  She amused me in many ways.... the least not being that she never stopped talking.  She would ask questions, I would get one word out, and then she would plow on with whatever thought was next in her head.  She would ask me about experiences I'd had in my past, and then, without stopping to take a breath, she'd say things such as, "Weren't you just so mad/angry/frustrated/ecstatic/fill in the blank?"  It truly never stopped.

And then one day she said, "I would be a great counselor, because I am so good at helping people with their problems."

I didn't respond.  Out loud.  I loved her and loved her hair cutting and coloring skills, but there's no way I would have sat in her therapy chair.

It was all I could do to refrain from giggling.

It is not a counselor's responsibility to solve a person's problems.  It is an individual's responsibility to move forward to solving his/her own problems.  It is a counselor's responsibility to listen, listen, listen, validate, re-frame, gently challenge and let the person come to the solution (solution) that is best for him or her.  (There might be a little more to it than that, but that's a good start.)

What happens when we don't feel listened to?  Well.  That's a pretty easy one, right?  Think about the last time you felt that a best friend, partner, parent, sibling, child, etc. wasn't listening to you.  What might have followed?  Misunderstanding.  Frustration.  A sense of shutting down.  Anger.

Maybe an argument ensued.

Why?

There is so much that is implied with being truly listened to.  When we're listened to, we feel validated.  We feel understood.  Our defensiveness comes down.  Maybe we feel like now that the problem has been hashed out, we're a little more released to take action.  And when we're not listened to?  Exactly the opposite.

(Before I start this next paragraph, please remember, as is stated in "Legal Issues" above in the pages, that nothing in this blog is intended to diagnose or treat.  The following is merely a couple of anecdotes about how difficult listening can be.)

When I participated in marriage counseling with the former spouse (ooooh, we're getting a little personal now!), we were speaking in session about how critical it is for couples to truly communicate their needs to each other, and how it critical it is for the receiving partner to listen and respond.  Former spouse indicated that the past week had been "exhausting", as he felt I was trying too hard to listen.  He said, "I shouldn't have to tell her what I need.  She should just know."  The marriage counselor tapped his pencil on the desk a few times.  Cleared his throat.  Stated, "I'm not sure that's a reasonable expectation."

Former spouse did not listen to that piece of advice.  (That is not why the marriage ended.  But it did not help.)

Today, when I see couples in therapy, I often find that communication is a key problem.  People haven't quite practiced how to be gentle, clear, firm and honest about what they need.  People haven't quite practiced how to actively listen, rephrase and ask for clarification.

These are not skills we are just born with.
It would be easier if they were, maybe.
Actually.  That would definitely be easier.

If you're in couples counseling with me, we'll inevitably do an exercise. This one is not complicated, but it requires a lot of set up. Here it is:  one partner speaks for five minutes while I model active listening.  When that person is finished, I model rephrasing and asking for clarification, and then I ask the person who was speaking how it felt to be listened to.  I then ask the partner who was observing what s/he noticed, and if s/he has any questions.  Then I complete the exercise with the other partner and listen to him/her.  Then I have the couple practice with each other and I elicit and provide feedback.

This can take A Very Long Time.  It takes an entire 50 minute session (usually more than one), and it's usually something that we practice for weeks.  (That's ok by me.  I'm in it to see change, so if it takes awhile, it takes awhile.) It can be a very frustrating thing for couples to go through, and often, I see conflict increase a little while things are getting hashed out.  (Most counselors give a little spiel that things will often get a little worse before they get better ... we're bringing up emotional topics, practicing new skills ... change takes courage.  And sometimes a glass of wine [as long as we're free from addiction issues].)  But then?  After awhile?  I can usually tell when mini breakthroughs happen ... because the couple will come in to my office (or right now, I'll come to their home, as that's my current modality), and there will be a sense of peace and love that wasn't there before.  Not perfect, but something has shifted.  There's even a sense of pride and smugness.  O, how I love that.  They absolutely should be proud of themselves.

Active listening is no easy task.  It can exhaust you.  Sometimes when I come home from work, I need an hour to myself, to just ... not listen.  I love my job (capital L), but I need that slight break.  We do the hard work (I as a counselor and families as family members) because it's worth it.

It should be easy, I know.
If it were so easy, though, the issue wouldn't come up again and again in our personal lives.

This is how this post ends:

"Being heard
is so close to being loved
that for the average person
they are almost indistinguishable."  -- David Augsburger

I learned that one in the church.

(This is part I of a few posts on listening.  I have no clue when it will end because I don't know when I'll run out of things to talk about.  Also, I might get bored.  Could go either way ....)

I have a therapist friend I love wholly and dearly.  She is the type of girl to have a glass of wine with, to get ridiculous with and to laugh naughtily with.  Lately, I've had some personal stuff going on and I mentioned something briefly to Friend about it.   Just to put my busy-ness in context.  I wasn't being coy on purpose.

She asked, "Do you want to talk about it?"

I said, "Nope."

She asked, "Because it makes it bigger, huh?"

I said, "Yep."

But that wasn't really the truth.  The truth is that I'm extraordinarily picky about with whom I share my stress.  And I am extraordinarily picky  because when I've got Big Stuff, I really need people to listen, really listen, to not try to relate what I'm saying to themselves, and to be empathetic.

Easy right?

Nope.

(Friend, by the way, is a successful therapist who builds incredible rapport with her clients.  I'm sure she listens well to them.  Maybe it's because we're friends, but I do not like trying to have serious talks with her.  I have just a few people I'm able to voluntarily go to when I have problems.  And this past year?  Ohhhhh, man.  Those poor handful of people!)

Listening is super hard, guys.  It can be incredibly difficult and exhausting to be fully present with someone, especially when you feel like you can relate and want to tell your story, and perhaps even more so when you don't agree with what the person is saying.  In my new job, I have 28 days to work with clients -- Approximately 40 hours of therapy.  That's an incredibly short amount of time, and you know what it's recommended we spend the first 6-10 hours doing?  Active listening.  (Oh my word.  I just asked Shoes what the hardest part of listening for him personally was, and he said, "Not injecting my own narrative into the person's story before they finish."  Somebody's been listening to the therapist in the house!)

It should be easy, right?  I mean, you just use your ears and listen, right?  Maybe it should be ... but it just isn't.  We spent the first several hours of core counseling class in graduate school learning how to listen actively, reframe, ask clarifying questions, etc.    Why?  Because you have to listen intently to start to understand the other person.

Let me tell you what.
That RUINED me.
Once I had a few experiences of genuinely being listened to, I started to get super frustrated when I felt like people weren't listening to me.

And let me tell you what.
That was incredibly VALIDATING for me.
Once I had a few experiences of genuinely being listened to, I realized the sheer power of knowing that I was being held and valued in another person's eyes.  It was deeply humbling and I felt deeply, deeply loved.

So, in this first part of this series on listening, I'm going to tell you two stories of what it feels like to be deeply listened to.  One is my own.  The other is from a past client.  (All identifying information has been changed about this client and the dialogue is re-created - no direct quotes).

My story:

2012.  Second year of graduate school.  I was interning at an inner city community outpatient mental health clinic in Southeast Portland, and I had just started to receive, as clients, families who scored higher on service intensity instruments. One of the families I was assigned was a father and step-mother who had recently regained custody of the father's 15 year old teen.  While in another person's care, the teen had suffered intense trauma, and, when referred for therapy, was engaging in behaviors one might expect from a 15 year old who had suffered intense trauma.  Father and step-mom were at a loss, and their way of dealing with the behavior, before therapy, was to blame and punish.

This hit a nerve with me.

While I understood, fully, that they were doing the best that they could, my heart went out to this teen, who was so thoroughly and utterly lost, lonely and hurting.  I was describing my own counter-transference in group supervision one day, and my group supervisor, who had been listening intently, said, "I think maybe you have a personal experience that is helping you to really understand this teen."

And I did.  In a long, rambling verbal vomit of monologue (ugh - sorry group!), I went on and on about my time working in juvenile detention and the things I had seen:  foster kids who misbehaved so they could get out of foster homes and come to juvie, where they knew the routine, knew they would be fed and warm, and knew we loved them; kids who came from abusive homes and asked us to please not return them back to the same environment; kids who were heavily gang involved on the "outside" who turned into loveable balls of bad body odor (well, they were teens after all) on the "inside".  As I talked, and as the group listened, I was able to tap into this strength I had in me - this experience of working with kids people didn't want anymore - and I was able to gain clarity into what I had to do therapeutically.

I walked away from that group supervision with more confidence and more resolve.
I felt a little more complete.
It was wholly and completely validating.

A client story:

The middle aged man came into the mental health clinic asking to speak with a crisis counselor.  "I need help," the man said, "finding housing."  Finding housing was not considered, by agency standards, a mental health crisis.  And to meet with this person, I had to cancel scheduled ongoing clients.  I could have referred the him to community resources and declined to meet.  He was also, honestly, menacing and rough looking - heavily tattooed and burly.   (That wasn't prejudicial thinking.  That was me thinking about safety.)

But.

But, the person was looking at me like he knew I was going to say no.  And that appeared exhausting.  I will never forget the look in his eyes.  There was no hope.
So.

What if?

I met with the person.  And I heard a long story of medical health issues - bills that couldn't be paid - assets that had to be sold off.  Relationships that were lost.  Complicating effects of the poverty that followed.

It wasn't a crisis by agency standards.
My other clients, who were cancelled, were frustrated the next day.

But here's how this ended.

At the end of 90 minutes, after listening, reaching for emotion, leaning forward and making eye contact, I gave the client a couple of resources that hadn't been tried yet.

And as he staggered painfully to his feet, looked at me and said, "I knew you weren't going to be able to help me."

I nodded.
After all, that sounded true.
And truthfully, I heard that a lot in crisis mental health.

But then he said, "And I will never forget that you chose to listen to me.  And it has been a long ass time [editor's note:  he said something a little more dirty than that] since anybody has done that."  And then tattooed man cried a little and shook my hand.

That was a good decision to make that day.

*******

And you, reader?
Was there a time you were so genuinely listened to that you felt loved in every fiber of your being?

Soldier's new mission:  Finding homes for female vets

I almost re-tweeted this article (linked - please visit and read for yourself).  I've learned to be a little careful, though, with that.  It's my responsibility to think about what re-tweeting says about my viewpoints- and especially what articles might convey (intentionally or unintentionally) about my view of others.

The article broke my heart in many ways.  Women veterans becoming homeless after returning from duty.  Women and children incredibly at-risk:

"While the Department of Veterans Affairs reports that overall veteran homeless rates are going down, female rates are going up. In fact, female veterans are the fastest-growing segment of the U.S. homeless population and are more at risk than their male counterparts, according to the report."

It has always been hard for women with dependent children.  The military has not been forward thinking in helping female veterans meet the unique challenge of having children and facing deployment.  Punitive, maybe, even.  (Is that going too far?)

Help comes in the form of a woman, Jaspen Boothe, the article describes, who is helping women veterans access transitional housing.  After facing similar challenges, including cancer, the military referred her to social services.

"They referred her to local social services, which Boothe called probably the most demeaning experience of her life."

Oh Goodness.

I wish I could accurately describe how demeaning it IS to access social services.  Forms are convoluted.  Waiting lines (and times) (even in rural areas) are long.  I've met many front desk staff (definitely not all) and social workers who are rude, judgmental and extremely condescending.  Applying for social services is a long process in which your intelligence, worth and dignity are continually called into question. You are continually asked, "What did YOU do to get to this point and what are YOU going to do to pull yourself out?"

(Sidenote.  Top causes of poverty:  illiteracy, health and income.  Now.  Think about what causes illiteracy, poor health and income.  We must, we must, we must, we must be careful to absolutely divorce the notion of poverty from personal effort/laziness.  I cannot even begin to describe how much more complicated the causes of poverty are.)

So Boothe has my heart in the palm of her hand, right?  And I'm soaking in her story to see how it ends, right?  And then this line pops up,

"  'I'm not a welfare mom, I'm a soldier.' "

Which came after this quote,

"You're treated basically as a baby's mama or a crack head, or some woman who's made a bunch of bad decisions with her life, and the only resources available were welfare," Boothe said.

And the record on the needle scratches and I instantly decide that I'm not re-tweeting this article.

Boothe found herself in the position of needing social services after falling on incredibly hard times.  She found that she needed transitional help.  Well, glory be -- turns out that the purpose of welfare is to help people transitionally.  Turns out that the myth of the welfare mom is rampant and that most people who use cash assistance or food stamps do so .... transitionally.  Turns out that Boothe fits the description of somebody who needs the assistance of ...welfare.

So does that make her a welfare mom?

I guess so.  Technically, right?  And I say that without any judgment or prejudice.  We have to start combating that term and the prejudicial attitude it conveys.  Boothe served her country (and continues to do so as she works with the VA).  I'm so grateful for that.  And I'm so very, very sad and disappointed that when she went to ask the country she so unselfishly served for help, the country made her feel demeaned and demoralized.

What's a welfare mom?

I have friends who, as a result of the recent economy, have used the assistance of food stamps.  WIC.  The cash grant.  I had single friends in undergraduate school (when this was still a possibility) who received food stamps to help them eat through the end of the month.  I have friends who, in the State of Oregon, which as a provision for this, received $1200 in welfare benefits to help flee domestic violence.

Are there people who abuse the system?
Yes.
Are there people who are dealing with addiction who receive welfare benefits?
Yes.
Are there MORE people who use welfare transitionally?
Yes.
If you research academic journals will you find the last statement to be true?
Yes.
Does this country have large prejudice and misinformation regarding who receives welfare?
I think so.

I commend Boothe for her work with female veterans and I wish her the best as she moves forward in continuing to act selflessly for the sake of others.  I sincerely thank her for her service to this country.  May her journey be blessed beyond belief.

And may we all start to examine the attitudes we have to people who receive federal / state assistance.

(I am proud of the "welfare moms" I know.  Because sometimes asking for help is infinitely harder than it should be.)

(Back on the soap box again ... I've written about this before ... I'd stop, but it keeps popping up ...)

As a social worker / therapist, it's easy to develop pet peeves.  As in, really easy.  As in, it's probably a good thing to watch those immediate reactions you start having to people - OR - you might lose sight as to what's really important:  empathy / respect / appreciation for the journey most of my clients have been on.  (Most people don't just wake up one day and think, Man, today would be a GREAT day to (fill in the blank) ....)

I'm an in home family therapist for families who are at immediate risk of losing their children to foster care.  When Children's Administration (meaning, CPS, or Child Welfare, or the Department of Children and Family Services, or whatever variation your state has) calls me, things have gotten pretty hairy.  That's a euphemism.  I don't really want to detail right now what kinds of things happen in homes that help facilitate my presence, mostly because when I do that, the back story as to why families are going through the hardships they are gets lost.  Most people are not psychopaths.  Most people do not want to hurt their children.  That might be hard to believe, but people's stories are so widely varied and complex.

I mean, really, really complex.  Do I get frustrated?  Sure.  Do I have to call in new CPS reports?   Sometimes.  Do I still have hope?  Absolutely.  Do some families make it?

Do some families make it?  (Not a typo.  I asked that twice.)

Some families stay together, and people have widely varying definitions of success.  I've had to really, really examine my class issues in defining success and have had to really, really examine how comfortable I am with the concept of minimum sufficient level of care.

Oh, my word.  I digress all over the place.  The job is complex, much like many jobs!, and I find myself re-explaining what I do again and again out of habit.

Back to the point.  I have worked with children and families for 12 years.  Not always as a therapist.  Not always at the Master's level.  But I have a lot of experience with kids.  I've seen a lot of kids heal.  I've seen a lot of kids go through some earth shattering,  heart breaking experiences.  I've been around kids.

I've been around kids who have been physically or sexually abused.  I've helped take injury photos of bruises and I've listened to kids disclose physical torture.  I've advocated for them in court.  I've worked with kids in therapy who have PTSD because they've witnessed family members die in gang shootings. I've detained some of them involuntarily to psych beds for their own safety.  In one season of my life, I was a Detention Officer and I physically restrained them for their own safety.  In that same season, I stayed up all night with them when they had nightmares, wet the bed, needed someone to talk to.    I have chosen a life of public service (long hours, terrible pay, etc) because my heart is wrapped up in kid healing.  This is a choice I have made.

(Loop back to the beginning of the post ...)

So I do not take it well when people tell me, "You'll know when you're a mom" - or - "You don't understand because you don't have children."

I was in a training today on cognitive interventions and REBT when a training participant purposefully ignored a statement I made, turned to my co worker and said, "Well, you know about kids, because you're a mom."

Sweetheart, I have been to more dark places with kids than most moms will ever go.  I do not know what it is like to be a mom, but I know about kids, and what I know is that giving birth does not make you an expert on all things child.  (I didn't say that.  I took a drink of water and doodled on my handout.)

Strangely, none of my clients have ever had a problem with me not having kids.  Some of them, in our closing work together, have stated that they had initial concerns that I would not be able to relate because I do not have my own kids, but that those concerns dissipated quickly.  I have only ever received the cold shoulder from some colleagues (not most), conservative Evangelical moms (not all) and some acquaintances (my good friends are generally supportive).  I do not have to have schizophrenia to treat schizophrenia.  I do not have to be suicidal to treat suicide ideation / depression.  I do not have to have kids to be a good kid / family therapist.

Also, strangely, Shoes and I are having long, complicated discussions about when to start our own family, (if we start our own family), with no clear answers as to when, in part  because I am so busy taking care of other people's children.  (Calm. That's not the only reason the discussions are complicated).

So.  In sum.  My uterus is empty.  It might be empty for a good long while. And me and my empty uterus?  We're still a good family therapist.  I can still jump rope, shoot baskets, make a worry box, and depersonalize an issue like nobody's business.  I haven't stayed up all night with a colicky baby, but I've stayed up all night with a suicidal teenager.  I haven't dropped my 5 year old off for his first day of kindergarten, but I've worked hours and hours and hours to get a child the special education service he desperately needs.

Not a mom.

Still an advocate for all things child.

Funny how that works.

I've majorly violated my one big New Years' Resolution for this year, which was to live 12 months with no major life changes.  In this case, though, I think a major life change was needed for my health (see previous post) and the health of my family.  (A husband and a dog is a family.)

I've resigned from my job as a child and family therapist with the community outpatient mental health clinic.  Hearing Shoes say (over and over and over and over), "We can sell the house, babe.  We'll move back to Portland.  It will be ok." made me realize how much sadness and grief and stress this job was bringing into my home.

It hit me really hard about a month ago when Shoes said quietly, "You can't go on like this.  This depression is eating you alive."

Depression?  Well.  Not really.  I mean, sad and stressed out and trying to rely on God's promises, but I know that I didn't match the clinical criteria for depression.  You gotta watch how you label mental health around a therapist. But the fact that Shoes was experiencing my situation as depression was a bit of a shake up.   I have more to say about the job I'm resigning from, but I'm looking for a graceful, diplomatic way to own my truth and not slander the agency.  And I will probably wait until I've fully left to write that post.

Before I resigned, though, I accepted an employment offer from a parent agency in a town a couple hours away who was looking to expand services in my county.  So.  I am still a child and family therapist.  Now, I am a child and family therapist who will be providing intense, in home therapy to families who are either:  1) At imminent risk of losing their children to Child Welfare; or 2) Having their children returned to them out of foster care.  This is gloves off kind of stuff.  The kind of therapy that happens as a last chance resort to try to keep families together.

I'm going from one intense agency to another, I know.  Here's the thing though.  With the new agency, my maximum caseload is 2.  2 families.  Now, each family gets 10 hours of in home therapy a week, but I will never be assigned more than 2 families.  And paperwork is written into my work agreement.  And here's the thing that my heart is the most grateful for:

I will be working from home.  I will not be away from the house 12-14 hours a day.  The implications this has for Shoes and I is huge. We might actually have space to start thinking about human children.  We'll see.

I have 3 more client days at the clinic.  This has been tough.  Due to the very high turnover at the clinic, I am the 3rd or 4th therapist these kids and families have had in the last 12 months.  These families are upset, and understandably so.  It has taken all of my professional energy and clinical skills to be able to hold their disappointment, irritation, frustration, fury ... and grief and loss ... while experiencing my own.  I have never ascribed to the school of thought that I, as a therapist, should be a blank slate.  Especially not when working with kids and families with a history of trauma and attachment issues.  (No worries, I'm not letting myself fall apart.  It's been several days of lots of emotion, though.)  It's also been incredibly difficult to professionally, yet with empathy, respond to statements such as, "That agency must be a really terrible place to work if they can't keep any of their therapists"; or; "I don't know where you're going after this, but it has to be better than (my agency)."  (That last one was from a professional I respect and admire.)

I've been working almost every day, many hours a day.  My last day with the current agency is Wednesday, and on Thursday and Friday, I'll drive up to the parent agency for initial training.

If anything, the past 9 months has taught me how important the health of the agency is in social work / social services.  That's obvious, right?  Maybe, but it's really difficult to assess that in an interview.  I know to ask more questions early on now.  I know to ask for what I need.  I know to ask, "What makes a person a good fit for this agency?".  Maybe I won't always get straight answers, but I can only do what I can do.

It's beautiful outside right now.  I went into the agency this morning and worked on cleaning up client files.  And then Rosie and I went to the dog park.  It's time to start putting this behind me.  It's time to start remembering why I wanted to become a therapist.

Oh, social work.

I have a dear, dear friend from graduate school  I remain very close to.  (That sounds more committed than it is - I've only been out of grad school for 9 months).  We chat, he tells me about social services in Portland, I try not to get too homesick.

Lives will be saved, literally and figuratively.
Lives will be lost, literally and figuratively.
Social workers will stumble upon creative solutions to impossible situations.
Social workers will be stumped and will have no idea what to do next.
Clients will show up on time for their appointments and be motivated to work to change.
Clients will no show.  Maybe it isn't time for their season of change yet.
There will be slow afternoons.
There will be afternoons where you don't get a bathroom break.
Social workers might get hugs from little ones.
Social workers might get kicked by little ones.

This week in social work, I will be officially starting my new position in the agency as a child and family therapist.  That's new to the agency, but not necessarily new to me.  I've done this before.  I've loved this before.

I love it now.

I will go to work tomorrow, clean up my adult client's files, take a precursory look at my new kid files, and then head North for 3 days of training (a state required clinical training in how to work with sexual assault victims).  That's a lot of heavy stuff during the day.  It will get to be a little much, I'm sure.  It usually does.  But I will not be in the office.  Not be running around.  Not responding to the ER to evaluate people for involuntary detainment.  It's a break.  A break listening to the effects of sexual trauma, but a break none the less.

I will also miss Rosie's last day of puppy training, but Shoes will do a good job of holding down the fort.  He always does.

And then, another weekend.

And then, bring on the kid therapy.
I'm so ready.

(footnote:  I was in therapy for a year and a half after a very sad divorce.  truthfully, i don't remember much of those early days of therapy because i was just trying to get up, go to work, not react to people when they told me divorce was a major sin against God and not fall apart.  those are actually signs of emotional trauma - the not remembering.  however, i very clearly remember the day my therapist asked me, "where do you go from here, lisa?  what do you want to do?  where do you feel most alive?" and i said, "when i'm working with kids at my job and at church."  and it was like God put a firm foundation under my feet immediately and said, "start working on this kid, we've got work to do."  my head cleared and my heart actually started to feel a sense of light and purpose and direction.  so i applied to graduate school, moved away and specialized in kid therapy.    i am almost 5 years past that day in my therapist's office.  it is no small secret i adore the life i've been given now.)

It still hasn't really left me, and I am in no way personally tied to the events in Newtown, Connecticut.  (Not personally tied other than being a member of the human race, and thus, my heart breaks accordingly to the pain all families involved struggle with.)

I sat on our couch, with Shoes on one side of me, Dog on the other, sobbing quietly while we watched hours worth of news coverage.  Shoes teared, too.  There came a point where he softly said, "We have to get out of this house for awhile."

Because we knew we couldn't not watch.  (And even as we left, we were fully cognizant that we had the choice to leave this pain for a bit.)  As we drove away, we talked about when the words "mental health services" and "gun control" would pop up.

This post is about mental health services.
Gun control might be a different post.
I might skip gun control altogether.
We'll see.

The phrase that brought on this posting is the phrase:  "We need better access to mental health services in America."

So before we start, let's be honest about myself as a writer.  This post is in no way unbiased.  I am a 34 year old, Caucasian, middle class, heterosexual woman who holds a Masters Degree in Social Work, specializing in community outpatient mental health.  As a human being, I hold a ridiculous amount of privilege and cultural capital.  I say that because I recognize it and I want to invite you to honestly call out my biases as you see fit if you choose to comment.  I am completely open to that.

I know some of my readers have counseling backgrounds, but for those of you who might not, community outpatient mental health translates to:  I provide counseling services to a population who is assisted by Medicaid/Medicare.

When Adam Lanza heartbreakingly caused so much pain in Newtown, one of the first things I heard was, "Isn't it a shame, the state of mental health services in this country."

1.  Yes.
2.  Let's be careful.

Let's be careful because the coroner is still waiting on the results of Adam Lanza's toxicology report to see if there might have been any psychiatric medications in his system.  Initial reports seem to have initially suggested that Adam had Asperger's.  Let's be careful - AND - let's be clear.  Disorders on the Autism Spectrum are not mental health disorders.  Disorders on the Autism Spectrum are developmental disorders.  Violent behavior is not a characteristic, necessarily, of people who have disorders on the autism spectrum; while violent behavior may occur in people who have an autism spectrum disorder, the aggressive behavior is often directed towards the person him/herself and is often a result of being unable to effectively communicate needs, wants, frustration, etc.

Ok.  We're good with that distinction, right?  We can move on?  It was slightly tangential, but it irritated me to no end to hear news sources incorrectly link autism to mental health disorders.

Now.  Let's talk about the state of mental health services in my area.  (Because I don't know what it's like, but I might be able to guess, in Wyoming.  Or Texas.  Or New York.  Or Delaware.)

My agency is drowning.  We are drowning in a crush of people who need mental health services.  Our intake numbers are high.  After intake, there is most often a waiting list to get on a therapist's caseload.  Often times I have 6, 7, or 8 back to back appointments of ongoing therapy clients a day, which often get CANCELLED because we all cover crisis mental health calls as well.  Here's the shocking thing:  there are only 22,000 people who live in the county I primarily work in and just 2,000 people who live in the other county we serve.  The State of Washington estimates it takes between 2 and 3 years for mental health workers to gain enough of the required hours to apply/test for mental health licensure.  At my clinic, we average about 1.5 years.  Even though the population is so low, the need is so very high.  We have a disproportionately high number of people who live below the federal poverty line, are addicted to drugs/alcohol and who have severe (SEVERE) trauma histories.

Mental health services work best when there's a wraparound component, right?  We do have a chemical dependency team at our agency.  They are truly fabulous.  We do not have a detox center in all of the county or a homeless shelter.  Remember Maslow's hierarchy of needs?

So, tell me, in this rural county that has almost no services, how exactly I am supposed to address higher order cognitive thinking errors when what many of my clients are truly focused on is where they are going to sleep tonight in the 5 degree weather.  (This is when I start to miss Portland, because, even though the homeless shelters could be difficult to get in to, they still existed.  They were there.  And many churches opened warming centers in the winter.)

Here's another thing.  The clients we help qualify for Medicaid or Medicare (either food stamps or medical or TANF or SSI, etc.).  There's an entire population of people we have to turn away because they exceed our limited income / state assistance requirements, yet, they find the cost of a private counselor to be overwhelming.  We have a tiny grant to assist us with people who barely exceed the financial qualifications but can't afford a private counselor;  I don't feel like talking numbers, but even that is insufficient.

The state of mental health services in America?
It's in shambles, dear hearts.
The boat is sinking and we're using teaspoons to try to empty out the water that's pouring into said boat.

I work with a talented group of mental health therapists.  Seriously, show-stoppingly talented.  Sometimes we work 32 hour shifts.  We do not get paid well.   We barely have benefits.  We try to work on re-paying our student loans, but ... ha ha.  We want to meet with our on going clients.  We want to do the work.

There are barely any resources to do the work.
Often it seems like there are barely any benefits to doing the work.
Reaching 2 years as a therapist at my current agency is considered a true milestone.

So what do I do?

I write letters to congresspeople.  I am there for my clients.  I am there for my co workers. What do I do?  I keep going to work every day, 12 hours a day. I pray a lot. I  believe for the best a lot.  One of the scriptures I hold on to from my old church days reads, "I would have lost heart had I not believed that I would see the goodness of the Lord in the land of the living."  And so I believe that the goodness is for the living.  The here and now.  That change is possible now.

I want to end on what might seem to be a random note ... and that is:  who is it that is needing mental health services in America?  Who are those people who need therapy?

I would like to introduce myself as a consumer of mental health services.  I have struggled with anxiety intermittently for years (currently doing well with a combination of relaxation techniques and mindfulness approaches).  Had therapy on and off in the past.  Have taken a medication in the past (I almost identified which one, but then, remembering one of the goals of this blog is to NOT diagnose, treat or recommend, decided against it) for anxiety.  I come from a family who struggles with severe depression.  Many of my dear, many, and sweet friends have had:  anxiety, depression, bi-polar, trichotillomania, ptsd, adjustment disorder, schizophrenia .... Who are these people who need mental health services?

It is all of us. We all do well when we all do well.  So when we talk about the state of mental health services in America, I would like to remind all of us that we are not just talking about people I serve in community outpatient mental health (people who are - quite erroneously - all to easy to demonize and blame for their problems).  I am speaking about myself.  My family.  Possibly you.  Possibly your family.  Your neighbors.  Your friends.

The state of mental health services doesn't look too hot.  (I went to graduate school to be able to construct that well educated sentence.)  But those of us on the inside do it anyway.  And many of us will continue to do it.  But if you yourself are concerned and you're wondering what could be done, do me a favor.

Do not get caught up in fear.  Do not get caught up in demonizing people with mental health issues.   (After the shooting, I had a FLOOD of calls from my regular clients, in tears, mindful of the fact that they have been consumers for years, asking if people really believed they were going to hurt them.)  Do not suggest that all mentally ill people be hospitalized.  Or jailed.  If you'd like to be constructive, contact your state assembly-people and ask them, as they look at what budgets need to be cut, to consider the long range impact of cutting mental health services.  If you'd like to be constructive, call some of your local mental health agencies (county mental health is often a good place to start) and ask how you might help.

And be well.  And speak kindly.  And act lovingly.  To others, and also yourself.

That is also constructive.

... but it happens.  All the time.

In 2008, I entered my first little courtship after my divorce.  It was kind of cute.  It lasted for maybe 10 cute little weeks.  I respect the man it was with.  We had different ideas about life.  We had different ideas about where our little courtship was going.  He broke up with me twice.  But I was ok.  After the 2nd time, it was high time for me to move on.

I'm not sure we agree on what happened (which is code for I'm pretty sure there is large disagreement about what happened).  We have a lot of mutual friends, but this boy and I, we don't really talk anymore.  It still feels a little awkward.  But who's to drag things out?  I moved to Portland and got on with my life.

I got this job in August and found out I would be helping to cover mental health services for not one but TWO rural counties.  The other county is partway between here and the Vineyard Town.  The other county is the  boy's hometown county.

Now.

This isn't really a problem.  Several of my present co workers know the boy's family, and know him, and have heard a little about what happened, but I don't waste a lot of time explaining myself.

It was four years ago.

It's all good and fine until you've driven to this other rural county three horrendous times in one night to cover crisis.  I put 250 miles on my car that night (and 250 hard miles on my SOUL.  Just kidding.  Kind of.).  In the morning, when I was getting a client ready for transport at the hospital, the county ambulance's team came in and who should be in charge?

The boy's father.

He gave me the look that said, I think I know who you are and I think I know what happened.  I was going to do the polite rural thing and re-introduce myself, but there just wasn't time.  It just wasn't appropriate as we were discussing what type of restraints, if any, would be helpful.

Funny how in these rural counties you never fully put your decisions behind you.

I came home the next day and told Shoes, who laughed heartily and said, "Oh man.  Who would have known that this would keep hanging around you?"  Shoes doesn't care so much.  He likes this other boy.  Thinks the entire situation is amusing.

So here I am.

Back in Rural E Washington.

And even though I purposefully  did not return to the Vineyard Town, the Vineyard Town still has a hold on me.

Well, blessed be, I suppose.  Next time I'll just tell Bob the Ambulance Driver that I remember who he is.  That's another rural thing, I think.  You just have to own it and be out with it.

Horizontal linkages and such.  Theory right down into practice.  Sigh.

So it's my day off.  I work four 10 hour shifts.  But I commute an hour each way.  So I work four 12 hour shifts.  But I always end up staying late.  And technically, I'm on call every weekend.

So this is my day off.  I had big hopes for today.  Take Rose to the dog groomer (check).  Get the car title in my name (check).  Do some Christmas shopping (check).   Meditate.  (Oops).  Yoga.  (Oops.)  I am excellent at taking care of business.

I am not always excellent at taking care of myself.

It is my day off and I am waiting for Shoes to get home for our date night.  While I wait, I'm lost in Ted Talks.

How I love Ted Talks.

When I interned as a geriatric counselor, the activities director used to show Ted Talks and lead discussions in the auditorium.  It was a beautiful time of learning from people who knew far more about living than I do.

This is the Ted Talk I love the most today:


Ms. Adichie speaks for approximately 18 minutes on the danger of a single story (looking at a situation, a person, a culture from a single narrative).  I wish I could explain to you how strongly this resonates in my spirit.  I wish I could tell you how I was struck with the sheer ingenuity of her thought.

Although Ms. Adichie primarily addresses the story of our cultures, I couldn't help but link it back to my own experience in social work.  I wish I could tell you the bizarre and irritating things people continually tell me about the people I partner with in my job:  People who cope with mental health issues.  People who are living in poverty.   People whose children are in the custody of child welfare.

There is no one single story and our human lies are varied and complex beyond measure.

Here's what Ms. Adichie writes:

"The consequence of the single story is this:  It robs people of dignity.  It makes our recognition of our equal humanity difficult.  It emphasizes how we are different rather than how we are similar."

How are we looking at people?  What are the unspoken value judgments behind our emotional reactions?  What are the stories we've heard and continue to tell?

Let's examine those.

 

And that's certainly not because I'm not thankful for anything.
Also.
I've really loved reading the everyday (and not so everyday) blessings that you've enjoyed (and I have enjoyed through you).

This Thanksgiving, there's a few things I find myself being deeply grateful for ... right now ... this year brings a host of blessings, but let's save those for the end of the year post ...

So, right now ...

...the opportunity to humbly partner with my clients as they develop new narratives
...the absolute courage of said clients
...grace
...forgiveness
...humility
...kindness
...love
...listening
...sacrifice
...stillness

Also ...

...raucous laughter
...winter air
...Rosie galloping in the snow
...orange mochas from Thomas Hammer
...text pictures of my sassy Goddaughter, Rebekah
...the smell of Rosemary (don't know, just love it)

Above all else ...

...a God who loves humanity more deeply than I will ever figure out
...a partner who is more deeply fantastic and wholly good than I could have ever asked for
...this life.

(ellipses don't work here.)  This Thanksgiving, I am also reminded that I am placed in a position of privilege -- privilege awarded to me due to absolute no merit or hard work of my own.  What I'm thankful for is fundamentally shaped by this privilege because my experience as a human being is shaped by this privilege.  This privilege is a slippery slope, and I am thankful for the daily opportunity to deeply examine it and, in any way I can, to use it as an ally.  I am grateful for those in my life who are not at all afraid to call out this privilege.  I am grateful for that discomfort.  I am grateful for the opportunity to realize how much I do not know.  I am humbly grateful for the learning.

Tongue in cheek ...

I am grateful that the Cougar Football Season is over and that my wonderful Shoes will be returned to a place of non dispair.  Please join with me in praying for Coug Fans the nation over.  May they know a season of less heartbreak next year.

Be blessed.  Enjoy your families this holiday (those blood and those you have chosen).  May we move forward in the rest of the year truly remembering how grateful we are today and not lose sight of that in the upcoming weeks.

I live in an extremely rural area where my options for employment, especially without a social work license, are extremely limited.  I wanted to work for Community Outpatient Mental Health (a Medicaid Vendor), and there are just two agencies within a one hour commute.  One agency wasn't hiring.  The other, a miracle!, was.

I'm not sure if this post will be helpful (what kind of "n" is one interview?), but to graduating MSW students, here's a little of what you can expect in the job interview process (at least for a mental health agency!  I'm not so sure this will be helpful if you're interviewing for community building positions ...)

1.  I interviewed with the clinical supervisor, the HR director and the Executive Director.  I only had one interview, but I hear from my friends who have entered the field that completing two interviews is common.

2.  Be pleasant to the front office staff when you arrive.  Seriously.  This is not a group of people with whom you want to start off on the wrong foot.

3.  Know your therapeutic approach.  My own therapeutic approach is rooted in social constructivism / narrative therapy; however, the agency I work with is a cognitive behavioral therapy clinic.  I researched this beforehand and, thus, it wasn't a surprise. I was able to speak to when I found CBT most helpful.  However, the agency is also open to creative work with clients (an excellent thing in days of limited resources and funding!), so I felt free and confident in explaining when and how I use narrative therapy.

4.  Be able to speak to an ethical dilemma you've faced in the field, and more specifically, how you addressed it.  What was your decision making process?  Who did you consult?  Whose interests were you taking to heart?

5.  Be able to address a DSM dx.   I mean, really address it.  It depends on the agency, I suppose, but I was given free reign to choose a dx, speak to the criteria and explain when I might diagnose a person appropriately.  This means knowing the criteria fairly well (no worries if you don't know it exactly, remember, the DSM is only supposed to be a tool for the clinician and it's impossible to memorize it!), being able to speak to how functioning would be impaired, and being able to speak to differential dx.  Here's the bottom line:  Do you know how to use the DSM?

6.  Know your values.  What's most important to you?  When I was asked to tell a little bit about myself, I confidently spoke to my belief in the change process and my investment in anti-oppressive practice.  As a social worker, I felt this was imperative to commit to early in my days as a therapist.

7.  Know how comfortable you are with ambiguity.  That might sound a little odd, but I was given several hypothetical situations in which there clearly was no "right answer".  I knew I hit the nail on the head when I wrapped up my response with, "There's not always going to be a clear cut answer, but you do the best you can do with the information you have at the time.  You commit yourself to the client and doing good work, and in the end, the power you yield over any given situation is somewhat limited."  Smiles and furious scribbles all along.  We can't control the outcome.  We can only contribute our best to the process.

8.  This one isn't actually mine, but I have several friends who have completed interviews in which they were puzzled over the seeming simplicity of the interview questions and wondered if they had responded fully.  I remember when I used to ask fairly basic questions to potential Guardian Ad Litems; I wanted to see their response style.  I wanted to get a feel for their ability to use common sense.  If it seems too easy, take a deep breath.  Don't get arrogant or over confident, but rest in your abilities.  You're letting your interviewers know who you and what your style is.  Be comfortable that that's more than enough.

If you have any questions, please feel free to comment here.  If you have any ideas to contribute, please feel free to comment here, too!  And please know that I'm so grateful to be able to call you a colleague in working to the empowerment of others.  Be blessed!

As I deal with the inevitable semi shock of leaving my nurtured, protected cocoon of graduate school (where we talked about empowerment, micro aggressions, and anti oppressive practice) and entering the work force of crisis mental health in a very rural area (where examining our values is all too often replaced with "we just received another call from the ER, we have 2 other workers out on crisis, who's got this?"), I find myself struggling with the classic symptoms of overworked social workers everywhere:

Fatigue
Feeling overwhelmed
Waking up at 3, wondering if I turned paperwork in
Failing to keep a work/life balance (and not being the most popular professional in the room when I bring that up)
Feeling resentful that my time is never really my own
Letting my other interests lie dormant

It's different for everybody.

Self care is a strange topic in the helping profession, I think. We know that we need to care for ourselves as we respond to the critical needs of others. We know we need to at least try to pretend to prevent burnout. So we throw around ideas like "take a warm, relaxing bath" or "read a good book" or "exercise at least 3 times a week."

Cough.

I know very few workers who actually do these type of things.

My own personal belief is that most of the workers I know are female and have also taken the responsibility of caring for their partners and children as well. They'd love to take a bath.

There's no time.

(That paragraph was astoundingly gender normative. I apologize and acknowledge that families are complex and varied. And I would like to applaud my dear MSW friend, B., and her husband, The Mr., for what seems to be a beautiful blending of responsibility sharing and mutual support in their family).

I've no doubt that things like baths and walks and reading books help some people. Truthfully, though? As I start to address my own needs as I continue to respond to dear souls near suicide (as that's now the limited scope of our crisis mental health agency), "taking a bath" just doesn't even feel close enough to what my soul needs.

My soul is a hungry, thirsty little creature that needs much more than that.

We talked about this in grad school. I had an advanced practice instructor who believed, absolutely, we should get enough sleep and eat good food and take care of our bodies. And she didn't believe it was enough.

Because here's the problem, dear hearts: when you work with people for so many hours during the day, and then sometimes visit the ER again at 2:00 am if it's your on call night, the emotions and metaphors you start to have and identify with aren't full of peace, love, and unicorns tooting glittery, anti oppressive rainbows.

I'm tired. I'm frustrated. I don't know if this person's situation will change. I'm upset with the police / nurses / docs. I'm scared I don't know what to do right now. I can't be a part of this dysfunctional social service system anymore.

But we're professionals who are continually trying to advocate for humanity, right? So how can we possibly admit that sometimes we have human emotions and that sometimes we are just so over everything. All of it.

This advanced practice instructor I had believes this is where the heart of self care is. We must know what we're feeling. We have to take time to check in with ourselves so that we're not completely overwhelmed later. We have to know that we're feeling exhausted, infuriated, grieved ... And instead of warring with ourselves (you're a terrible social worker who should never feel irritated; your co workers never do; keep it together, genius), we need to be gentle with ourselves and meet these feelings with compassion.

It's like this: if a child we loved came to us with a serious problem, our hearts would be moved with compassion and we would immediately respond, most likely, without judgment because we would just want her to feel better. We would join with her and nurture her and soothe her.

We are deserving of that same compassion.  We need to truly know what it means to accept whatever we've got going on in that moment (for better or worse) as what we've got going on in that moment.  If we don't know that for ourselves, we will, dear hearts, have a very difficult time modeling that for our clients.  I like myself needs to be more than a pop psychology phrase.  I like myself is more I understand what I'm going through right now and I meet that need with compassion.

I think Susie (the instructor) is right.  I think this is the heart of self care.

Here's what else helps me for self care.  This is my frosting:

1. I remember my faith roots.  I am a progressive, left, social worker.  I am a Christian.   For me, these two things do not compete.  (If you have questions about this, please let me know.  I'm happy to expand and engage in dialogue about this.)  On my way into work, I spend time in prayer. 

2. I also meet with a meditation / walking meditation group. Sometimes my days go from 4:00am to 9:00pm (from the commute to work, to making dinner and taking care of the dog at night) and I don't always have time for a daily practice. That's ok. That's where I am right now. So I meet with a group on Sundays. This is an hour and a half of clearing my brain and breathing. Sometimes I spend time in formal prayer during this time, too. A little unorthodox, but I have to do what works for me.

3.  Remembering to communicate well with my husband and to voice my feelings / needs.  Sometimes, at the end of the day, I am so very tired of talking about emotions.  I'm exhausted, but I still have needs.  Taking a deep breath, and honoring and speaking to my needs actually honors him:  he's not a mind reader.  The more open communication we have, the more I am fulfilled in  my marriage.

4.  Vinyasa Yoga.  I have chronic shoulder pain that is exacerbated by stress.  I usually only have time to do this once or twice a week.  That's ok.

5.  I take time on Sunday evenings and plan my week.  A look at the planner, especially as we're trying to buy this house!,  helps me focus on what the week will look like (as much as I can.  Crisis work is crisis work.).  I also use this time to plan our menus for the week.  This helps a TON with not eating out at night.  Additionally, because I commute an hour each way to my job, it helps me think about what food I want to be eating for lunch (and therefore avoid fast food) and what snacks I want to put in my crisis bag.  This is a little tricky; fruit and veggies are perishable and mashable (and oh, man, is that gross when that happens).  I like nuts.  Power bars.  Bottles of water.  Sometimes I'll cut up veggies and put them in a Ziplock bag; I just don't always remember to eat them.

These things help.  But, as I've mentioned, it's the frosting.  The heart of self care is taking care of the center of us.

Sometimes this blog gets quite a few readers, but few commenters.  That is perfectly ok.  I've kept this blog for six years with commenters coming and going.  But if you, who are involved in social service, are reading, and you do have a moment to share, what do you do to take care of yourself?  How do you know when you've forgotten to?  How can we honor each other and support each other in doing this?

... When you have a community outpatient mental health clinic that's been slammed with crisis?

A bunch of harried therapists, closed office doors and rushed comings and goings. The need is great, my friends.

To cope, I'm in denial and writing this post. Later, though, I will hug my husband and my dog and write emails to dear friends.

Here's a pic of Rosie in her Yoda Halloween costume. Why? Because this is my moment of self care and she makes me smile.

...of gratitude.   And remembered the successes.  And prayed.  And thought about everything in the bigger picture.

I'm still here.

Of course.

In case you hadn't guessed, I'm a little neurotic.  One of those neuroses is I hate (so hate) to be thought of as anything but kind and compassionate.  And I can't, of course, control other people's feelings or thoughts (and they are, so often, entirely separate from me or anything I could have said or done).

I think we might be on the other side of the accusations.  Time will tell.  No formal complaints were filed.  Yet.  I know my character.  There were other therapists and law enforcement present that will attest to my actions.  All of that is pure and logical and, even if a formal (false) complaint was filed, my hope is that  my past work, my current work, and the witnesses that were there would cover the allegation.  (I obviously can't speak about it in detail.)

But still.  It still grieves me a little.

These things have helped:

a therapist team that has stood by me.  a supervisor who essentially told me to get over it.  whispers that i was hired so quickly because the agency couldn't bear to pass me up.  messages of competence.  good (i mean, heart breakingly good and productive) sessions with clients this week.  finding stillness in the storm, and in that, re-finding the love for human beings that drives my work.  text messages from BreAnna and Katelyn (thanks, girlies, you have no idea...) and messages of love from Cherrie.  a husband who snorted and said, "good grief, wife.  why are you even worrying?"  a husband who then said, "Of course you wouldn't do that.  you're more the steal children type of worker"  (said tongue in cheek, dear readers).  a sister who said, "are you joking me right now?"

All of these things help remind me of who I am and what I'm really trying to do. 

Big picture.  I think that's my life lesson of late.  Keep in mind the bigger picture and don't let the worries (of which there might be several) of the minute chain me.  It's funny that I'm focusing on that right now, as this is the same lesson that's being paralled by so many of my clients.    We're all just focusing on being here, right here.  Right now.  Breathing in.  Breathing out.  Figuring out our true selves. 

I adore this poem by Thich Nhat Hanh (1978) and have been meditating on it often.  It's displayed in my office and it often catches the eye of co-therapists and clients alike.  It helps me stay connected - to you, my husband, my co workers, my clients .... and even those who don't yet know what it's like to speak truth.


Call Me By My True Names

Do not say that I'll depart tomorrow
because even today I still arrive.

Look deeply: I arrive in every second
to be a bud on a spring branch,
to be a tiny bird, with wings still fragile,
learning to sing in my new nest,
to be a caterpillar in the heart of a flower,
to be a jewel hiding itself in a stone.

I still arrive, in order to laugh and to cry,
in order to fear and to hope.
The rhythm of my heart is the birth and
death of all that are alive.

I am the mayfly metamorphosing on the surface of the river,
and I am the bird which, when spring comes, arrives in time
to eat the mayfly.

I am the frog swimming happily in the clear pond,
and I am also the grass-snake who, approaching in silence,
feeds itself on the frog.

I am the child in Uganda, all skin and bones,
my legs as thin as bamboo sticks,
and I am the arms merchant, selling deadly weapons to
Uganda.

I am the twelve-year-old girl, refugee on a small boat,
who throws herself into the ocean after being raped by a sea
pirate,
and I am the pirate, my heart not yet capable of seeing and
loving.

I am a member of the politburo, with plenty of power in my
hands,
and I am the man who has to pay his "debt of blood" to, my
people,
dying slowly in a forced labor camp.

My joy is like spring, so warm it makes flowers bloom in all
walks of life.
My pain if like a river of tears, so full it fills the four oceans.

Please call me by my true names,
so I can hear all my cries and laughs at once,
so I can see that my joy and pain are one.

Please call me by my true names,
so I can wake up,
and so the door of my heart can be left open,
the door of compassion.

Thich Nhat Hanh

I graduated school in June, not sure if I was ready, but entirely sure I was ready.  I've said it before so many times:  this time in the field isn't my first rodeo. 

This is my 11th year in the field.  Those 11 years have seen ups and downs; births and deaths (literally) and dry spells and periods of amazing growth.  I have experienced, with clients, situations that have helped me seen the goodness of the Lord in the land of the living and client situations that have made me think the good Lord is hiding.

I can't really blog about this job.  I wouldn't want to lay people's most vulnerable selves out for others to see.  The trust that I'm trying to build in the therapy room is sacred.  I'd do almost anything to protect it. 

But these past few weeks on the job have kind of knocked me down.

And that's been surprising.  Because this isn't my first rodeo.  I've looked into how hurt people can be and how serious mental illness can be and how violent human behavior can be.  I've already seen that. 

What it comes down to is this:  these past few weeks I have been lied to and lied about.  The lies told about me are big, absurd and somewhat scary .... this is such a sensitive button for me ... few things bother me more than having the character I have worked so hard to build up attacked.  All of my clinical skills have been deeply challenged.  I find myself starting to questioning my previously unwavering belief that people can change and grow and heal. 

Most of you know that I am no longer truly a part of the church.  I don't attend on Sundays.  I don't serve a ministry.  But as I was driving into the valley on Wednesday, a relic from my early 20s popped up, and I find myself putting on the helmet of salvation ... the breastplate of righteousness ... the belt of truth ... the shoes of peace and readiness ... and picking up the sword of the spirit ...  And I'll tell you what ... that morning, I was clinging heavily to that breastplate and the shoes of peace.  

Please just let me just bring peace into this job.  Into the agency.  Into my therapy office.  To my coworkers.  And especially, especially, especially ... into the lives of people who are learning how to overcome and deal with mental health issues ....

I am one month into this job.
I  just received my Master's diploma in the mail this afternoon.
I am somewhat ashamed to say I am already wondering how long I'll be able to do this.
And I know it's just too soon to be this defeated.
It is.
It is too soon to feel this defeated.

So I'll take these next three days and I'll re-boot.  Recharge.  Rethink.  I'll sit and be and wait for the peace.  I'll breathe deeply.   I'll cling to what I know.  I'll remember the hard times that I have had in the field (and some of them have been horrid) and then I'll remember that I'm still here.   I won't avoid these horrible feelings of self doubt and fear and mild exhausion that I'm having now (exhaustion = 7 hours on the same crisis call over the course of an afternoon / evening).  I'll treat these feelings with love and compassion.  I will find something to be grateful for.

And I will remember and list out all of the success I've experienced with clients (or they have experienced without me) over the past decade.  Because people do grow and change and heal. 

They do.

and i'm not entirely sure i want the skill.

i've been writing up my first solo mental health assessments at internship, which essentially means i'm the lead clinician looking at the appropriate axis I mental health disorder.  we're a community outpatient mental health clinic, and insurance will only pay for treatment if there does, indeed, exist an axis I disorder.

i have a really hard time diagnosing children.  i know much of the dsm criteria for childhood disorders upside down and inside out - i use it every stinking day at my job in psychiatry research at ohsu.  it's not that.  it's a tricky process with minute details and differential considerations, but i don't get turned off emotionally by its trickiness.

rather, i have a hard time putting the onus of responsibility on kids because kids come from families and families interact.  and some of the kids i see are very, very young.  (some are 17, but some are 6.)

diagnoses mean different things to different people.  some parents are relieved to hear that a group of professionals agreed that the set of sxs their child is experiencing warrants a clinical name.  some parents accept the label for treatment purposes, but prefer to think of their child without the label.  as many different perspectives as there are stars in the sky.

and it goes back to power.  shoes and i have many, many conversations about the incredibly odd and almost unwanted power we have in certain situations.  shoes sent juveniles to kid prison.  he sent adults to adult prison. i've provided countless episodes of court testimony re: my professional opinions about parents' ability to parent their children.  now i'm the one giving people labels that tend to stick around for long periods of time.  it's an alternate universe.  you do the best you can with the training, graduate education, best of your common sense and qualifications the state gives you.

and in the end, you're still putting a label on another human being.  still saying, "this is what's wrong with you."

my group supervisor shared this excerpt from Alice Walker a few days ago.  it fits in many ways -- especially around my work with teens.  especially around my work with children who are brought into the clinic for "behavioral problems."   it fits better with who i am.  i return again and again to it.  i remind myself that the dx is a means to an end ... and the end is a loving, hopeful connection with a human being.

"In the Baemba tribe of South Africa, when a person acts irresponsibly or unjustly, he is placed in the center of the village, alone and unfettered.  All work ceases, and every man, woman and child in the village gathers around the accused individual.  Then each person in the tribe speaks to the accused, one at a time, about all the good things the person has done in his lifetime.  All his positive attributes, good deeds, strengths and kindnesses are recited carefully and at length.  The tribal ceremony often lasts several days.  At the end, the tribal circle is broken, a joyous celebration takes place, and the person is symbolically and literally welcomed back in the tribe."

if i can just remember my passionate desire to work with people in remembering their own strengths, their giftings, their preferred ways of being ... maybe, maybe i can balance the therapeutic process with the task of diagnosing.

... and all of the detainees had come out of their cells and were waiting by their doors for rec to begin, i looked around in the early morning stillness and saw each of them for their vulnerability and their potential.   all of the past offenses (the whining, the misbehaving, the arguing) melted away and it was a sacred time of being able to see their genuine selves.  i wondered if they knew how beautiful they were.

then rec started and the whining resumed.

they were still beautiful,

this week i started leading my first parent group and it was a big group  - 16 parents in all.   their backgrounds were remarkably different, their goals were different, their perspectives were different.  some parents had elected to be there; some had been ordered by child welfare to be there.  in those two hours of group, however, they were vulnerable and scared and optimistic and looking for things to change.  it was a sacred time of being able to see their genuine selves.

i wondered if they knew how beautiful they were.