O FLOURISHING WORD

 

He was not my client, he was my next-door neighbor’s, but I often passed him sprawled in the hall on my way to and from the waiting room and photocopy machine. Sometimes he was with another boy, but mostly he was alone, turning his yearning face up at the sound of any steps.

From my first friendly hello, he wanted to claim my attention. If he had blocks, he wanted me to build something; if he was holding a board book, he wanted help reading. His sweet appeal stopped me in my tracks despite my need to get things done, but his needs ran deeper than a few minutes’ interaction. Because I always had other things to do, over time I weaned myself from crouching for a chat to whisking by or pausing above him like any other adult on the move.

Almost unfailingly I had to ask that he clear sundry diversions from the center of the floor so that people could navigate to offices beyond. My requests always seemed to take him by surprise, as though the bit of variation I tried to work in week by week succeeded in creating brand-new experiences.

“Hi, nice to see you again!” “You look like you’re having fun!” “Wow, did you build that?” I might compliment a racetrack for marbles, or a scene composed in a plastic box of sand. Those openings were my prelude to asking the same old question, after which I made sure to express thanks.

Poor little guy—bounced from home to home, never in his own. His exile to the hall was meant to allow my colleague time to educate current caregivers on his need for love, rather than the kind of respect-based rearing still thought to raise good citizens, wherein respect equals obedience.

During one of our last such encounters, I felt a little self-conscious about asking him to sideline himself yet again. So arms akimbo, I asked, for novelty’s sake, “Now, what do I always say to you when I see you?”

“‘Good job,’” he quoted in reply.

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Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. I’m deeply grateful for my readers, and as always, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

 

SUPERPOWERS.

 

 

For a lesson in heartbreak, ask a foster child what superpower she would choose if she could. I did, this evening, and her answer was, “Read minds.” I feel like those two sentences ought to tell a story in and of themselves, but my view may be colored by my second-hand exposure to the issues. Her parents’ long-standing neglect hit a little more consciously this week, when her mother didn’t bother to schedule a visit with her. One phone call, free transportation from the state, three hours’ commitment. Told by her foster provider that her father has been “sick” lately, kiddo said, “I know he does drugs.” Meanwhile, her foster family, whom she clearly loves with all her yearning soul, would not be able to keep her even if she hadn’t started acting out and creating divisions among them. My theory, not especially perceptive: She knows her fate won’t lie with them, and she simply cannot bear it. Because she can’t bear it, she’ll likely be moved all the sooner. But when? Where to? How will she be treated? Will she ever feel at home, ever belong? The ability to read minds would give her a map, a compass. The country itself would likely be no less hard.

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Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. I’m deeply grateful for my readers, and as always, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

IN PRAISE OF SUNLIGHT AND ESPRESSO

 

 

The conscious practice of gratitude sometimes needs a little help. Throughout the dark and rainy weeks of mid- and late Fall, it was the promise of an en-route espresso that motivated me out of bed when nothing else did. If I could make time to stop for that, I would have five minutes, maybe ten, that I knew I could savor. You see, I’ve come to dread my job. I hate typing this here, with such finality, in a space I’d consecrated for inspiration. I care as much as ever about my clients, and feel their faces and voices and stories intertwined with my own. But before, between, and after client visits, I’m in agony to leave and be done. A bureaucratic setting is not for me; I need to work for myself. And, importantly, I need to write. I dream the plots of stories—characters and predicaments that I want to see on the page. I hate typing this, too, in a way, because it gives me such a concrete challenge, one that others might hold me accountable to. What if I don’t have what it takes? To which I answer myself—and you, if you hold similar doubts—joy, heart-throbbing joy, is always worth the risk. I hope to keep reflecting on my tenure in community mental health; there is so much to say. I rely on 2019, however, to be a year of change.

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Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. I’m deeply grateful for my readers, and as always, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage! Thank you for your visit—and all good things in 2019!

MISSING PIECES

 

It was a cold, rainy November day in community mental health. I was stood up for the third week in a row by a parent who nonetheless makes no move to end services, meaning that I have to send a letter that indicates concern (without getting too personal) and points up my outreach efforts (without sounding overbearing). Despite a background in writing, such communications are grueling for me.

I spent 25 minutes on the phone with a juvenile probation officer, discussing a client’s obsession with his ex and his legal situation related thereto; then hung up and promptly wondered whether I’d betrayed his confidentiality in the little bit of talking I’d done, something that will likely nag at me long after my supervisor reviews it with me. I was beset and nuzzled by a hand-puppet seeking affection-by-proxy on behalf of a child I have frequently had to remind about personal space.

Holding respectful silence, I supported a young adult in the process of contemplating how much of her sexual trauma she needs and wants to share. I stepped with a mother and daughter into the furnace of long-fueled resentments. At one point, an adult psychiatric patient crunched through the snow to look in my window before continuing next door to pound on the glass of the doc, cursing and threatening him till police were called. Come to think of it, that’s what started the day.

Two client visits were easy and joyful and kept the lights bright in my brain after too many hours spent doing paperwork and hearing disappointing news. But the part of this Monday that I’ll remember most clearly is the call from Sue, a foster mother, to tell me about a question posed by my kindergarten client on the drive to school. Removed from her biological mother for gross medical neglect as well as alleged abuse, my client asked from the backseat, “Do you think you can love a person without liking them?” Six years old.

Every clinician I know has favorite clients and heartbreak clients, often one and the same. This girl stole my heart from the moment we met, and although I behave with the same playful professionalism I would with any client her age, I wish in a very real way that I could adopt her. That I can’t is one of a short-list of aches that descend from metaphor to dwell in my core.

I’d gone in early to finish an annual review, so the day felt extra-long. When I got home, my bootlaces wouldn’t loosen fast enough. Yanking, tugging, heaving, I got the right boot off, taking my sock with it. Stuck to the bottom of the sock, and hence to the bottom of my foot, the bottom of my day, the bottom of my ache, was a small puzzle piece. The crackled glaze on the curve of the Mona Lisa’s mysterious smile.

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Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me.

To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. I’m deeply grateful for my readers, and as always, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage! Thank you for your visit.

MANUALIZED LABOR

 

When I contemplated a career in therapy, one of the elements that made my eyes light up was the prospect of continuing education. I looked forward to formal learning that never stopped, imagining something akin to master classes by the greats of the field. I didn’t imagine hauling ass through rush hour traffic to watch PowerPoint presentations illustrated with memes.

So far only about twenty percent of trainings have inspired me in my work—a pretty shabby average. The rest have just cost time and money when I can’t spare either for things that don’t feel essential. Like most licensed professionals, though, I’m required to meet a quota of CEUs.

Still evolving within the work, I nonetheless developed the core of my professional identity and preferences relatively early, with the support of an exceptional first-year internship supervisor, who emphasized the primacy of the therapeutic relationship and the value of simply, truly meeting clients where they’re at.

That’s not to say that my supervisor, a school social worker with an agency background, didn’t utilize specific strategies, tools, and techniques—in her case, an adventure-based approach along with play therapy. Rather, those things became a seamless part of her work and never took precedence over the present-moment needs of the kids she saw.

The therapeutic modalities that so often comprise the training opportunities available, by comparison, tend to seem rote and too directive in their approach. Or they feel so to me. “Visit one is for general assessment using the XYZ Mental Health Inventory; visit two is for problem-identification with cognitive mapping; visit three…” Etc.

There are many reasons for the manualization of therapeutic processes, including the mandate for brief therapy imposed by insurance companies, and the “soft science” complex that haunts a profession seeking status in a mechanistic, data-driven world.

People who know me would probably agree that I’m a stickler about many things, from the quality of the food I buy down to the commas in a piece of writing. But holding clients to a rigid framework ain’t my scene.

You could say I care more about “practice-based evidence” than I do about “evidence-based practice.” EBPs can certainly boast success stories, and I’m sure they work best when employed by their strongest adherents. Yet I know many clients who’ve “graduated” from CBT, DBT, and other acronymnal programs and express that they consider themselves none the better.

Then there are the trainings that feel like mere repackaging of modalities that have come before, the therapeutic equivalent of the “seven basic plots” in literature. In cynical moments, you might catch me saying, Maybe if I took mindfulness, broke it into ten components, and called it “Experiential Sensory Integrity Development (ESID),” I could start a 401K on the proceeds?

Many trainings seem to involve no actual “training” whatsoever, merely glossing their subject matter within advertisements for certification processes that cost upwards of ten times as much as the cost of admission for the 6 out of 40 CEUs you’re sitting there to earn, before your two licensed years are up and you (pay an additional fee to) start again.

To put it metaphorically, the latter type of training consists of allusions to a destination that lies perpetually just around the bend. The scenery feels so unchanging, in the classroom or conference room or partitioned hotel space—Warning: complimentary peppermints contain red dye and GMO corn syrup—it’s as though the vehicle is immobile. In those cases, the answer to “Are we there yet?” is, There is no “there” there.

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If only I could write book reports to earn my CEUs… I’m deeply grateful for my readers, and as always, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. Thank you, and happy Fall.