understanding (n.)

Part 1.

Do you  guys hear this being thrown around?:

"They / he / she need therapy."
"They / he / she just need counseling."
"I hope they get him into counseling soon."

So.  Sometimes that's true.  Sometimes there are life events, or mood disorders, or family relationships, etc. that affect a person to the point that counseling - the opportunity to receive professional help in establishing new ways of thinking and new coping strategies (That's the abridged definition) - can be extremely helpful.  

Here's what's also true.  Sometimes hard things happen and people find ways to cope without needing therapy.  In the case of bereavement, for example, feelings of loss and grief might be extremely painful, but experiencing difficult emotions does not always mean you need counseling.  Sometimes allowing ourselves to experience painful emotions is the best thing we can do ... because we're allowing ourselves to feel and to move through it.  (Am I saying that nobody experiencing bereavement should seek out counseling?  Nope.  I'm just saying it's not always an automatic.)

I just got back from my hairstylist.  Good night sometimes she drives me crazy.  I was talking to her about how uninspired I am with my hair (this is a daily feeling for me), which somehow lead to me briefly mentioning that I was grumpy today.  Grumpy with my hair.  Grumpy that I have to drive 2.5 hours to a wedding reception tonight by myself as Shoes is in Utah for the away game.  Then she asked how "working on your family's little addition" was going and I simply stated I was grumpy about that too.

Well, I am.

Then she said, "Are you in therapy?"

Dear hearts.  Please do not ask people you don't really know very well this question.
It is RUDE.  And deeply personal.  (I also think we should let go of the stigma around seeking out mental health help.  But still.)

I stated I was not, and she said, "Well, I think you should be."
For what?
For being grumpy that my hair is alternatively a greasy / frizzy mess?  I think grumpiness is an appropriate response to that.
For being grumpy that I have to go to a wedding reception where I might not know anybody?
That's normal too.
And being grumpy that we're delayed in our family plans?  HA!  Grumpy is a MUCH preferred alternative to any number of things I could meet that with.

(Now, I should be in therapy because I'm a therapist, and it's standard practice for us to be so, but turns out I'm having a hard time finding a therapist who doesn't know me or my spouse's family in this tiny rural town....)

All this to say is that counseling is not always the answer, and sometimes we can find answers within us, or in our support systems, or our friends and family.   Or Jesus or God or Allah or Nature or Art or Yoga or Marathons or ....  (We know more than we think we know and can do better than we think we can do ...)

Sometimes counseling is most definitely the answer, but here's a little nugget about that as well.

Sitting in a counselor's chair / regularly attending therapy does not mean you're going to experience relief from negative symptoms or an increase in positive symptoms.

Why?

Well, that's Part 2 of this post, which is forthcoming ...

Sometimes when people are trying to start their family, it seems like everybody around them experiences the success they so ardently hope for.

Shoes and I have decided it's time for some sort of kid to  live in our house.  Actually, we decided this awhile ago, but with the old job, the changes this year, etc., it's only been in the past few months we've really been able to focus in on what this means.

Good Lord, what does this mean??

Well.  Honestly.  We're not really sure.  As of right now, we're going about this natural way, but when you're 36, the natural way reveals things about an aging female body.  Sometimes it reveals things that are slightly worrisome and come with all sorts of connotations.  In our case, we're still optimistic that things can be leveled out, and with the force of several supplements, we're moving forward.  (Many, many thanks to my dear friend B., who has termed this season in my life "reproductive misadventures."   I love that.  It makes it workable.  To me, that might mean that I read the map upside down and my luggage got lost in baggage claim, but there's still hope I can hitchhike back to down and the airline will contact me at some point.)

But there's still that question if it will work, right?  On top of the question, Shoes and I have always held adoption closely to our hearts.   We almost started the adoption process before trying to have our own; we've both had personal circumstances and jobs in which we've seen the ardent need for children to be placed with families who are in it for the long haul.

We're in it for the long haul.

Fostering, however, we're not interested in.  I realize that might sound calloused, but in this very, very small rural town, I would prefer to not have my community partners coming by my home at a moment's notice for 30 day face to face checks.  There's too much togetherness there, and I am far too opinionated.  Sometimes I agree with the Children's Administration.  Sometimes I bluntly and unapologetically don't.  But I have to have weekly meetings with those folks.  Shoes and I have agreed this is better left alone, for the sake of working relationships.

Kids.  We think we know what that means.  I think I know what that means.  Deep down, we know we have no idea what this means.  And we're ready for that, you know?  We had to come to a place where we were able to look that question dead in the eye and answer quietly, I don't know, but we stand in a place of faith and quiet confidence.

Also, when you get ready to have a family?  Holy moly, the free advice starts flowing like thick molasses.  I have heard Everything.  EVERY magic trick that GUARANTEES success.  And while I receive the advice in love (because I choose to believe that that was the spirit from which it was intended ...  MOST of the time), it becomes very overwhelming very quickly if left unchecked.

But don't worry, I'm checking it.  And letting go of worry.  And putting aside My Ultimate Plan.  One way or the other, it will happen, and Shoes and I will grow our family.  Rosie will have a human sibling.  We'll take family vacations to cheesy resorts.  We'll stay up all night with sick kids.  All of it.  

All the Everythings.

One full month at the new job.

I am no longer waking up at 4:00 in the morning, worrying about paperwork, clients and children at risk, or how much laundry is piling up downstairs.  I am not waking up at 6:00 in the morning on weekends out of a feeling of obligation, worried that I won't get everything done.  I am not bringing paperwork home with me (although that might be temporary and due to a lull in my caseload.)

I have responded to my first crisis call in the ER with this job.  I had backup.  I had a beautifully understanding ER doc and ER nurse.  I was paid appropriately for this wee-hours-of-the-morning-overtime.

And so now, in the past couple of weeks, I have noticed my attention starting to focus on non work related items.  I read a book.  For fun.  For fun, I read a book.  It had nothing to do with kids in distress, abuse or trauma.  It was lovely.  Shoes and I harvested a healthy crop of green beans and sat around the kitchen, munching on their crisp, earthy goodness, talking about how chunky Rosie is getting.  We have taken Rosie the Retriever swimming many times (as I no longer have to worry about being within cell phone range and, let's be honest, anything 5 minutes outside of town falls out of cell phone range.)

I signed up for yoga again.  And started exercising again.  And finally scheduled a facial for which I'd been given a gift card for AGES ago.

Also, we're going to Italy (I'm still good at non sequiturs, huh?), and it is one very lovely thing to look forward to and plan. Shoes' mom had 90 bajillion airline miles that had to be used; we're all going together.  This plan came together very quickly (so quickly it made me nervous - this planner likes to move slowly) and in a week we've booked the tickets, arranged for time off, applied for passports and arranged for Rosie's house-sitter (my MOM - who offered to come up from Central Oregon!).

I've also downloaded basic language learning software and have been plugging away nightly.  I'm not sure how useful knowing the plural forms for feminine and masculine nouns will be when I'm trying to order a glass of wine (unless I'm ordering several glasses of wine?), but it's fascinating none the less.

Today, I'm not sure what's on the docket.  Cleaning up the Rosie hair from the hardwood, no doubt.  Maybe building the compost bin.  The argula needs to be weeded as well.  Or maybe not.  Maybe I'll just watch movies all day.  I'm starting to feel like *I'm* finally in charge of my time off.

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.