understanding (n.)

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.)

Shoes and I.  An intervention, of sorts.  (Even though I'm not at all fond of that clinical model.)

We were talking about Rosie last night and I said (with my own mouth, and I don't think I was possessed), "Maybe we should get Rosie a friend."

We've talked about this before - getting a 2nd dog.  Shoes and I have jobs without flexibility; we're required to be away from home all day.  It's not lost on us that we have a big, slobbery Golden Retriever - the Lover of All Things Breathing.  We've never quite felt it's fair to this epitome of a pack animal to be home alone all day.

"But not a baby," I continued.  "I don't have any time to take off to coddle a baby (dog, people)."  (I do not have enough time.  I get 10 hours of PTO a month - that's vacation and sick altogether.  I've called in sick 2 times since I've been with the agency and have only managed to accrue 30 hours.  Self care?  Vacations?  Pffft.)

Shoes gets that.  Suggested maybe we look at the Shelter.  Go by ourselves, then take Rose, then see if we can foster a candidate for a bit before making a decision.

"You know," Shoes said, "That's great and I think it will be good for her, but I'll never love another dog like I do Rose."  He was kidding -- kind of.

But maybe he really wasn't.

Rosie got sick last night.  Big time puking.  Dietary indiscretion -- I guess that's what happens when  you consume 2 of your fabric toys in one day.  Still, it just broke our hearts to see her not feeling well.  She seemed under the weather for a few hours after that, which put us on edge.  She and I went to bed early and she kept curled up to me all night.  (Right.  She sleeps on the bed.  Right.  I know it was one of my cardinal rules to never let her do that.)  Even Shoes spoke very softly to her and gave her extra love.  We both turned in to big balls of mush ... even though not feeling well was *completely* her own doing.  (Shoes kept touching her nose to see if it was still dry.)

Rosie is a big pain in the tookus.  But she's learning.  And she's gentle.  And she's loving.  And I think that's what's endeared us to her the most:  she's never aggressive, never grumpy, and just gives and gives and gives and gives love.  There's an elderly couple who comes to our dog obedience class just to watch the dogs (it's really very sweet), and the man always says, "Oh Rosie, you're doing so much better sweetheart!"  And then the wife always tells us, "She always has such a huge smile on her face."  People stop us all the time when we're walking her to pet her and, even though her over abundant enthusiasm can be irritating, people always are so  pleased when she rushes them to love on them.    (I am always less than pleased.  Really, dog?  Show some decorum.)

We have a huge spot in our hearts for this animal that drives us nuts.  I don't know, maybe Shoes is right.  Maybe we might not be as fond of another dog as we are of Rosie.  Maybe it's nuts to want to get another dog just so she would have company during the day.

Any multiple dog owners out there have any advice?

We're listening.

Our dog did not behave like a rabid, demented animal during her 2nd puppy class (and because this post has been in draft form for a few weeks, she has actually had 4 total by now).   No barking.  Just a little whining. 

Sitting, laying down, walking on the leash?

Whatevs.  (I actually hate that word.  The only person I've ever really believed got away with saying that well is my 7 year old nephew, Michael.  He also says "totes."  As in, Rosie is "totes adorbs."  I sometimes have no idea what Michael is talking about, which makes me feel old.)

Anyway.  She had it down.  Still wanted to flirt and make googly eyes at the huge Malamute named Pufferbelly, but definitely improved.  Lots and lots of pats and loves for that.

She does love those pats and loves.

Want to know a secret?

This post isn't actually about Rosie.  But it was a good non sequitur.

I'm changing positions in my agency.  I had originally applied to be a child and family therapist at a time when the agency had openings for both the child & adult position.  The other top applicant stated she would only work with kids.  I was not in a place to be so picky.  I've enjoyed the last 6 months as an adult therapist.  I've appreciated the insight oriented conversations, witnessing change, and not having to keep sharp objects locked up in cabinets.

(Well ... the sharp objects one is context specific, I suppose ...)
And as much as I've appreciated working with the adults, I cannot wait (read:  canNOT WAIT) to get back to working with kids.  Because our agency is so small, I actually have a couple of kids on my caseload right now.  And you know what?

Right.  I love them.

The transition should happen mid February.   Very positive conversations with my clinical supervisor re: my role in the agency.  I've been unpacking my art supplies, my miniature toys for the sand tray I'm going to make, and hunting down used puppets.  (LOVE using puppets in therapy with kids.) 
To end this horribly written, random post, I'd like to tell you, as well, that one of my child clients has discovered a wormhole behind a dumpster near his home.  This is serious.  If you throw a rock into the wormhole, be careful.  It will come back to hit you in the back of your own head.

I know.  Creepy.  If you visit E. Washington, be sure to let me know so I can tell you which dumpster to steer clear from.

Kids.

I know, I know.  From mental health to Rosie to Shoes and back again.  But this is a personal narrative blog, so I get to do that, I suppose.

Disclaimer:  We just adore Rosie and would not give her up for the world.
Truth:  Rosie is exhausting.

We had Rosie's first day of Puppy Class last night and while I was under no presupposition that it would go well, I was not at all prepared for how badly it went.

Rose is not a barker.  She maybe "Arf!!'s" once every two weeks.  She's more the chew up your underwear, steal a bunch of bananas and run away, mischievous type of girl.  But she barked throughout the ENTIRE class.  I had no idea she could bark that much.  At one point the instructor had to politely ask us to quiet her.

Oh, honey.  If we knew how to do that, we would have done that.  But we were BAFFLED.  At home, Rose can sit, wait, beg, shake your hand, find a treat if you hide it and lie down.  At puppy class, Rose can run around like a demented animal with her tongue hanging out the side of her head and open her eyes so widely she makes you wonder if she has rabies.

And bark.  She can definitely do that.

She could not walk on a leash.
She could not sit down.
She could not pay attention.

And apparently many of the things we have been doing (as advised by the books we've consulted!) are not the instructor's favorite methods.  Such as:  turn away when Rosie jumps on you so as to withdraw your affection.   According to Puppy Teacher, we have to step into Rosie to invade her space.

Apparently, Goldens do not have a sense of personal space.

Heavens knows ours doesn't.

So here's the truth about me.

I'm kind of a jerk.  I like to know how to do things and do them well.  I do not like to feel embarrassed, and I do not like, above all else, to feel like people view me as lazy.  Unfortunately, alllll of those buttons got triggered at Puppy Class.  (Rosie even did worse than our friends - Tom and Judy - dog Vinnie.  Vinnie can be MEAN.  He's adorable, but he guards Tom and Judy with his life!  And Vinnie did better?  What?)  My attitude was so awesome afterwards that Shoes had to honestly tell me, "If you're going to be like this after every class, I don't want to go anymore."

So, I appreciate his honesty.  And Rose and I will work on our homework every day, twice a day.  And I will hope for the best.

Otherwise, I will start pulling my hair out.  Or start drinking wine before class.  Either way.

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.

I'm gearing up for a post on the state of mental health services in America.  Because, you know, obviously, (she said tongue in cheek) I'm the foremost authority.  (So, so ... not the foremost authority).  My thoughts are scattered though and I'm wondering how much to really share.  How much is enough to be authentic, but discreet enough to protect my agency and my consumers?  No genie in the bottle here, so while I wrestle, I'll share with you how big our darling Rosie has gotten.



We had our first snow weeks ago.  Rosie is a huge fan.  She likes burrowing, catching snow balls, sniffing and begs (BEGS) to slide down the hill with the little kids at the park near our house.  Of course, we don't let her do this as she would pin small children down and slay them with her 30 pounds of unbridled excitement.


Our new house.  Our new house from 1959.  O,  the work we have to do.  Rosie has decided that having her front half hang off the book shelf and her back half hang off the couch is quite luxurious.  We really shouldn't let her do this, but, you see, it keeps her occupied.  And keeping her occupied is worth its weight in gold.  She managed to take down that Christmas tree.  Twice.



But we forgive her for things like that because she is still such a puppy.  A BIG puppy, but a sweet snuggly girl just the same.



Snuggly still.



And on her favorite perch by the window.

Don't let her fool you, though.  She is still naughty.  And I mean, Naughty.
Puppy classes start 1/15.
I'm a little worried.
Ok.
A lot worried.