THE NUMBERS GAME, PART TWO (OR, MY SO-CALLED THERAPEUTIC LIFE)

One of the many challenging aspects of working in community mental health is that you are, de facto, expected to practice as a generalist. In Youth & Family work, this means taking any client between preschool and 21, with pretty much any kind of issue. It doesn’t matter if you have little to no training or skill with a particular developmental age or diagnostic picture. You learn as you go, or not. At least within the session itself, your clients sink or swim with you; elsewhere, other factors can and often do play the determining role in outcomes.

Of course, any profession will involve on-the-job learning. Still, upon reflection, does working without expertise or even affinity, in some highly sensitive cases, seem therapeutic? We have supervision, but not in vivo; we have training opportunities, but not often or intensively enough. As regards this lack of choice, I’m reminded of an obnoxious rhyme I heard while volunteering in a kindergarten, summoned on such occasions as the passing out of birthday lollipops: “You get what you get, and you don’t get upset.” Yes, in fact, you do get upset! And clients may get upset—rightly so, if they’re not adequately helped where such help might be possible but wasn’t in the roll of the dice. A prohibition against feelings and preferences helps exactly no one.

But back to generalist practice. Let’s say I have a caseload of 25 (again, as mentioned before, that’s on the most absurdly, luxuriously modest end of the community mental health spectrum). Let’s say the work week begins, and maybe I get lucky with an easy sort of Monday, six clients back-to-back but all doing relatively well. I may leave work feeling buoyant and thinking, optimistically, “It’s time I got around to reading more about blended families!” But then I remember that I started a book, some time back, on post-traumatic play, which is still relevant and likely ought to take priority. I decide that I should focus on that.

Tuesday, though, is rougher and brings fresh urgency to the need to research conflict resolution and nonviolent communication, to provide a distillation of resources to a weary and worried single parent who is hungry to learn how to talk to her teenage son before he slips away from her care and into a life of delinquency; she wants more than the basic guidelines I’ve already offered. I plan to assemble some things in the morning… Wednesday finds me, however, scrambling to photocopy materials on fight-flight-freeze and executive function, in order to best and most clearly explain brain processes to some guardians at their wit’s end and contemplating giving up a child, already abandoned multiple times, to the custody of the state. Her fate isn’t in my hands, but my success with the guardians feels as important as if it were.

Then Thursday? Thursday brings a mandated client who would probably rather chew glass or walk across hot coals than engage in therapy. I’m often successful building rapport in such cases, and even look forward to them, but this one’s giving me a run for my money, and my thoughts turn, yearning, to the book on motivational interviewing that I love but never have time to reread from beginning to end. Friday, my lightest day, nonetheless may remind me that if I had more expressive activities up my sleeve, I might better assist a boy in foster care who appears to lack the words for what he may feel.

I have hesitated over the subtitle, “My So-Called Therapeutic Life,” because to some extent it feels self-indulgent. First of all, yes, these are first-world problems. Second, I’ve had some truly amazing therapeutic experiences, and have been in awe of many of my clients and the challenges they overcome. I’m grateful for the chance I’ve had to start where I started and do the work that I’ve done. But I decided to include the subtitle because, as my colleagues and anyone who has ever worked in an agency all seem to agree, the pressures are such that there is little sense of grounded, focused, therapeutic practice. To summon the energy to try and create that experience for clients from hour to hour, can be exhausting and sometimes unrealistic.

I love reading. I love learning. I love doing good work. But, as it happens, I couldn’t live much better than hand-to-mouth on what I’m paid, in the part of the country where I currently live, and the stress of that is too much for me. So, when I leave my agency, it’s not to go home and read, but to race to another job, where I spend evenings and weekends. I average 65 hours a week, and it’s sometimes been up to 80. Additionally, in this milieu, we are buried in avalanches of paperwork, so I’m often working from home to try, in vain, to catch up. When I have free time, which is rare, I almost don’t know what to do with myself, despite a healthy number of outside interests. But I’ll tell you this: lately I spend most spare minutes dreaming of the day when I can leave my job(s) and start living another, more fulfilling kind of therapeutic life: one in which I can rest, nourish my spirit, and educate myself to better serve clients who are not stuck with me by lottery, but who elect to see me week by week. A life, for me and for clients, of choosing and making.

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I’m deeply grateful for my readers, and in 2018, 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 best wishes for (finally!) Spring.

META ON METTA

 

The end of any year brings seemingly innumerable invitations to make financial pledges. This is not one such! It is a contemplation, rather, on the merits of taking the whole process of New Year’s resolutions one step further, by creating or adopting a meaningful philosophical pledge, for the coming year and beyond—a pledge that, like metta meditation, moves you to consider your own life and the life of the world through the same lens—then post it somewhere prominent where you won’t fail to see it. A dashboard could work, for those idle moments in traffic. The back of a smart-phone case, as a tactile reminder on an abstract medium. A few valuable inches on your fridge.

I do my damnedest, in this writing, to maintain a positive approach to the subject at hand; I could opine all day long, but the virtual world is full of tirades already. I also try to be simple and straightforward; there’s an overabundance of glib commentary. With the conscious effort that my approach can require, I help reorient myself toward my own higher ideals—of which I not infrequently lose sight in my day-to-day interactions. I mostly write about my therapeutic work; but I’m no plaster saint, to use an old expression. As a child, I was asked to suppress my anger, and it’s still coming out now—mostly in the form of outrage over this and that aspect of culture, all the grievous injustices of which I’m aware, but also things that hit close to home and close to the bone, failures of friendship and emotional betrayals.

So: New Year’s resolutions are all well and good—my default is “Write more; swear less”—but I also need something bigger, deeper, stronger. Something to help me face the daily challenge of living, above and beyond a singular achievement, however important. My very first client, at my first internship, helped me to realize this. Whereas I had grown up in a broken-down neighborhood in a broken-down city, she lived a semi-rural life and loved her chickens with every fiber of her beautiful being—knew their personalities and followed events in the pecking order like a telenovela. Together we worked on validating her negative feelings, so that instead of being suppressed, they might transform themselves and empower her.

Through her, I came to be aware of the 4-H pledge: “I pledge my head to clearer thinking, my heart to greater loyalty, my hands to larger service, and my health to better living, for my club, my community, my country, and my world.” I saw her living out those values in continuing to love those who had hurt her, despite looking with clear eyes at their flaws, and rising above the chaos she’d known at home. The first four assertions have spoken to me ever since, like a nondenominational statement of grace. (I have mixed feelings about that string of possessive mys, and those feelings amplify as the picture gets bigger. Whose world? Our world.) An even simpler distillation of values, which for me is supremely grounding, is posted above my desk at work, a reminder to me and my clients: Be curious.

In 2018 and thereafter, I hope that ecosystems will be protected and valued as sacred, and that workers will be fairly paid and treated. I hope the humble honeybee, with its staggering commitment to fructifying the earth, will survive colony collapse. I hope that the rights of women, and various vulnerable populations, will be recognized and upheld. I hope that buzz words like “slow food” and “slow fashion” will build up to full-on movements, and that the doomed cultures of Agribusiness and Big Pharma will fall. Food doesn’t come from factories, and answers don’t come in pills. I hope that we collectively will have the resilience to develop the patience to labor on toward real answers—many of which can be found in traditions whose caretakers are indigenous peoples. And, of course, I hope children grow up feeling safe, loved, and respected. So many visions and wishes for our planet. I’ll be doing my part as best I can. I share these thoughts today, in this quiet corner of the internet—deliberately free from the commercial intrusions of ads—as an act of loving-kindness: I wish good things for me, and I wish them for you.

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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. If you enjoyed this piece, I hope you’ll consider sharing it. 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. “The Numbers Game” (July 2017), now long delayed, will be continued in a future post, when I have more stamina for the topic. Thank you for reading!

 

DANDELIONS

 

 

Near a local school, 12:30PM on this sunny Sunday, three little girls ran past me as I walked home from town. Two had hands full of dandelions; the third ran behind, calling to them—friends or sisters—to wait. It sounded like she was saying, “I don’t have any more!” Was she feeling left out? I remember that sensation all too well.

My next steps landed me in front of a perfect long-stemmed dandelion, recently plucked and then dropped on the sidewalk, so I picked it up and turned around, exclaiming, “Here’s one!” The girl stopped and did an about-face. “Here’s one that fell,” I elaborated. “Perhaps you’d like to have it.”

I held it out, and she approached. I extended my arm so she wouldn’t have to come too close to me; she reciprocated by reaching from a distance as well. She didn’t seem fearful, just wise and well-taught about strangers. Perhaps also surprised by my unexpected offer. Dandelion in hand, she turned and ran again, catching up.

Spending most of one’s time with traumatized children can make it, at times, almost startling to encounter other children in the world, children whose close and consistent care is evident. So it was for me this morning: a single glance took in the girls’ healthy complexions, tidy attire, and air of confidence.

I mused on the matter as I resumed my path. I had flashes of thought about the adverse childhood experiences (ACEs) of the children I’ve come to know in my work: neglect, abandonment, victimization, exposure to violence and substances; and flashes of the little signs of growth and change that mean so much to me, like a moment of relaxation in a face that’s usually tense, a self-protective girl I know whose laughter sometimes breaks through her reserve with as much light as those fistfuls of sunshine I’d just seen.

Then suddenly there was another dandelion before me on the sidewalk—and then another, and then another, and then another, stretching from my feet toward the point near the library where, one June night, I once had a memorable second first kiss. The girls weren’t losing their flowers; they were dropping them purposefully! What grand design were they enacting, with weeds that aren’t weeds? Leaving a trail of happiness behind them, abundant as the marigolds in Monsoon Wedding.

Picking one more up, I held it to my nose and breathed it in. How had I never realized how fragrant dandelions can be? I walked home amid lilacs, flowering trees, tulips blown open, massive bumble bees. I wished the good luck of this world on everyone.

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Out of respect for client privacy, names are always changed or omitted. Text and image copyrights held by me. If you enjoyed this piece, please consider sharing it. 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 for reading.

PAPIER-MACHE, IN TWO PARTS

This story starts at my inner-city parochial school, where supplies were so sparse that at one point we were sharing a single box of construction paper amongst grades Pre-K through 8. I can still recall my pride upon being chosen by Mrs. Z to leave my 1st grade classroom and walk down the grand black-tiled hall to request the box from another teacher—head held high in my state of importance, I fervently hoped to be witnessed.

What my school lacked in resources, it made up for amply in spirit, thanks in no small part to the cultural influence of the Spanish-speaking families in our parish. The Sisters who ran things, all Caucasian, embraced those families and honored Our Lady of Guadalupe. Looking back from this distance, in a culturally hostile hour, I admire the welcome offered by administrators who would have first come to know the neighborhood when it was all Polish, before the sugar skulls of the Day of the Dead bedecked the shelves of the shabby nearby bakery. A local woman was brought in to teach us Spanish hymns. Most thrilling were the piñatas.

Preparing for an all-school festival, each class worked together at long tables in the basement, soaking strips of newspaper in gummy flour paste and laying them bubbled and buckling over balloons. Smoothed, dried, painted, and strung up in the school gym—a magical transformation—they bobbed as each member of each class, taking turns, got to leverage one blind-folded swing, until a spill of candy hit the floor.

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The story continues with Cybil, 14, who was hospitalized several times for suicidality before she came to the agency seeking services. I liked her instantly, which made it relatively easy to build the rapport that is crucial with any client, but perhaps especially with teens; she had a mordant wit and a sensitive heart, both of which provided points of connection. One evening early on she interrupted herself and looked up from her mandala, colored pencil poised, and asked, tremulously, “You know I’m not doing this for attention, right?” It was already clear she had heard that accusation many times before.

Thanks to Cybil’s engagement in session and commitment to her therapeutic homework, within several months, she had stopped cutting—then, later, purging. Much of our work, though, still lay ahead. Ahead, and below.

In ways beyond my ken, I’m sure the speculated hard inner core and molten outer core of the Earth make all life possible; but the hard inner core of pain and molten outer core of anger, beneath a crust of scars and mantle of “behaviors,” almost cost Cybil hers. She told me that it wasn’t so much that she didn’t want to talk about things, as that she didn’t know where to start.

Reception at the agency had a vestigial practice of printing visit slips, despite the transition to computerized record-keeping. Several clients were aware, when they turned them over to me, that I put them in a file marked “To Shred.” As she and her mother prepared to leave one night, Cybil handed me hers: “Oh, here, do you want this for your file?”

“Sure,” I replied, “unless you’d like to keep it for yours.”

“I’ll be able to wallpaper my room with them pretty soon.”

Her mother and I exchanged quick looks; she seemed to hear what I did. All that stigma, writ large in Cybil’s life. “Why wallpaper?” asked her mother. “How about papier-mâché?”

“Yes!”—I seized on that. “What about a piñata?” Cybil liked candy, and she deserved a celebration. Transformation for transformation. “You could fill it with sweet things and baubles!” I imagined—I hope we three collectively imagined—a jaunty silk scarf tied above her fine nose and wide smile.

“I like that,” she said. Her mom agreed.

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Out of respect for client privacy, names are always changed. If you enjoyed this piece, please consider sharing it. To subscribe and receive future posts, please click the “Follow” button, accompanied by a plus-sign, in the lower right corner of your computer screen.

 

 

A COUNTERVAILING MAGIC

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Last evening I was running some errands in town when the owner of a tiny used-and-antiquarian bookstore, bald in the style of a sea captain, flagged me down: he had a couple somethings I’d asked for months prior. So I went in, and settled into a narrow armchair, losing track of time until I realized that his open sign hadn’t been up, and I was likely keeping him from his tea.

He waved off my apology; he was staying late, as it happened. A young man would be bringing his girlfriend by, to guide her toward a certain book with a carved-out center containing—yes—a ring. Once said young man had proposed, the owner would clear a space for a small, well-appointed table, and a local restaurant would provide a catered meal. (I didn’t ask, but imagined a lone violinist there as well.)

Hearing that, surrounded by a warren of shelves all but obscuring the ancient blue wallpaper, with a peach-faced lovebird singing in the other room— “Alas, in a cage,” said the bookseller—was an instance of countervailing magic, the current that runs against the ills of the world. Such encounters—magic is always an encounter in some form or another—restore me to joy.

There is a great deal of pain involved in working with children. My first client, as an intern, was a little girl whose mother punched her in the nose and took an ax to her father’s car; she couldn’t concentrate in class and wept for the loss of an animal she’d loved, plus everything else, tears that shook her frame. We did a sensory inventory one day, and the wind spoke to her and told her to find her own safe place in the landscape at home; she let a pond remind her of peace, and the sun shining through a leafy trellis bring her hope. Magic: her dear, intelligent face, as we meditated at a picnic table, beneath the tall tall trees and a vibrant sky. May it carry her forth.

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A NEW MYTHOLOGY

 

Luz's winter coat

 

If you were holding my resume in your hands, you might knit your brows in perplexity at my apparent vocational 180, from the literary arts to clinical social work. I had to justify that even for an unpaid internship. But the fields aren’t really so different: both involve stories, and the language we use to tell them.

From creation myths (the Raven who steals the light; the “Vows” section in the New York Times) to a well-written obit, I’m easily moved when a narrative thread drops a plumb line through a person’s or a culture’s history.

Stories aren’t without their hazards, though. In a single day, we can tell ourselves dozens, often contradictory, tracking the vicissitudes of feelings and fortune. Yet we tend to privilege certain of those narratives above others, sometimes with disastrous results. Many suicides, for example, could be seen as failure narratives: My life will never get better than this.

The interaction between biology and story is too much for me to take on here and now, but suffice it to say our biological states predispose us in narrative directions.

In relationships, our dominant narratives tend to map out the roles that we play. Many kids who come to counseling have been marked within their families as The Problem, so long and so exclusively that they seem to stand no chance of being seen as anything else. While parents may legitimately worry about safety and trust, kids equally legitimately don’t want to have to drag past mistakes alongside them.

The work of counseling, then, is to open up the story, let it breathe, and help it gradually evolve. I believe that we all deserve to play more than one role in our lives, especially to be both nurturer and nurtured. In some settings—at work, for example, or among acquaintances—relatively simple and fixed roles may make sense. But too many of us in our private lives conduct our own personal Stanford Prison Experiment, becoming the (unhappy) parts we play.

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My still-much-missed client Luz was, at age 8, a great storyteller. “Once upon a time…” was all I’d have to say, then I’d take dictation. This started in our first visit, when I was fired up to try a narrative technique I’d read about. Through a Spanish interpreter, I asked Luz and her mother to tell me a story with animals playing their parts. (Luz’s mother began to cry relating the story of a daddy wolf who got sick and couldn’t provide for his wife and their children. Fortunately, that story ended well.)

Shy and brief at first, like Luz herself, the stories over time became more complex, until near the end of our time Luz told me this one:

Once upon a time, there were two turtles, and one turtle was Mama and a girl turtle named Luz. Luz, she always played with her dolls. One day, Mama Turtle said, “I’m going to the store—you stay inside and don’t open the window or door!” Luz Turtle was not listening; she was playing with her dolls. Then someone knocked on the door. “Ding-dong!” It was a hawk! The turtle, Luz, she opened the door and said, “What do you want, Hawk?” The hawk said, “I’m here to ask for a turtle to eat.” Luz ran upstairs and locked the door. The hawk was angry and flew up and then down the chimney into the room. Then he said, “Open the door, or I’m going to eat you!” and the turtle said, “Not by my shell!” The hawk knocked on the door, and the turtle escaped from the room through the window. “Where is that turtle?!” said the hawk. The turtle ran and found a fox—a police fox! The police fox said, “What’s wrong? Why are you running?” Luz Turtle said, “A hawk is chasing me! He wants to eat me!” The police fox asked, “Where is he?” Luz Turtle said, “In my house, in my room!” The police fox went to the house to talk to the hawk. “Oh, Hawk, go away—find another turtle to eat!” The hawk said, “What are you going to do about it?!” “I’ll put you in jail if you eat this little turtle!” said the fox. “I’ll get you next time,” the hawk said to Luz. After that, Mama Turtle came home. “What’s going on? Why is everything open? I told you to leave the door shut!” Luz Turtle said, “I’m sorry, Mama. I wasn’t listening.” Then she told the story about the hawk.

THE END

Luz had come to counseling with generalized anxiety, much of it related to border-crossing, separations, and the INS. She couldn’t bear to see her parents drive away, even on short errands. By the time of this story, however, several months into counseling, Luz seemed to have conquered her anxiety. With decreasing worry and increasing confidence, she began to act out other roles of childhood—kicking up a fuss about going to bed, for example, when she wanted to watch TV with her older siblings. (Luz’s mom seemed to take this in stride, fondly stroking her daughter’s cheek. Would that all parents could retain such positive regard when discussing tantrums.)

I see in the story of the turtle in peril a meeting and mingling of two major themes, fear and disobedience, with an experience of protection and survival—however tentative that survival might seem, from the hawk’s parting shot. Privately, because I love foxes, I delighted in Luz Turtle’s unlikely hero. (Had I told her they were my favorites? I couldn’t remember!) Openly, Luz delighted in her own wit, her “Not by my shell!” a turtle’s version of “Not by the hair on my chinny-chin-chin!”

Luz, walking with me down the hall in her winter boots and pompom hat. From her, I learned a new genre: the preservation myth.

 

*Real names are never used here, to protect client privacy. Luz’s story shared with permission.

“WHY IS THAT A FEAT?”

Lucky Apple

I’ll say it again: I love the directness of children.

Sometimes it provides comic relief, as when, one September not too long ago, the school principal visited the kindergarten classroom where I used to volunteer, to greet the matriculating pupils. A little blond boy, who would become a favorite of mine, studied him quizzically—head cocked, hand on his chin—musing as if half to himself, “I wonder what happened to all of your hair…” The principal’s shiny pate flushed, and he seemed to choke on his words, but gamely he replied that he didn’t know, either.

Often a child’s candor is a refreshing change from the subterfuge of adults, with our emotional trench coats and back alleys, to say nothing of political doublespeak. Tikes playing with trains are the real conductors on the so-called Straight-Talk Express. (There are exceptions, of course, as I’ve acknowledged before.)

Last year I worked with a boy who’d been held back for issues that had been labeled “ADHD.” His family life was chaotic* from morning till night and undermined our therapeutic work during in-home visits in the same way, I’m guessing, that it limited his ability to do homework and engage in his own development. A meeting with faculty and staff at his locally notorious school demonstrated nothing so much as their lack of comprehension for his circumstances.

He and I had one precious office visit—our first visit, before transportation became a problem for his mom. I learned so much! We did one of my favorite focusing activities: I asked him to close his eyes while I struck my singing bowl, then raise his hand when he couldn’t hear its fading resonance anymore.** Then, I asked him to do the same thing, except this time when he could no longer hear the bell, he was to listen for anything else he could hear around him, and raise his hand when he was ready to report back.

I’m not taking authorial license to say that I’ve rarely seen such a look of concentration as on that boy’s face in the sanctuary of the office.

I was surprised and impressed to learn from him that there was more than one clock in the room; I had never noticed. (It wasn’t my space.) He was perfectly still and observant, without evincing the slightest self-consciousness. After, he spoke offhandedly of his excellent hearing. I exclaimed over his ability, in a different exercise, to shift his awareness from the top of his head to his right baby toe, such that both parts grew tingly in turn in response to being noticed; I called it a feat. After I’d defined the word for him, his response was, “Why?” What was so extraordinary? Graciously he seemed to give me the benefit of the doubt.

It’s a feat because it involves executive function. Because that’s an important way to use the brain. Because that’s the very area in which he was considered weak. Because, in fact, many of us barely notice our creaturely existence in this world, except in the most obvious ways. Because, because, because—so many possible answers. But really—why, indeed? It was a good question.

Speaking of feats, the apple pictured above was plucked from the orchard equivalent of Charlie Brown’s Christmas tree. And it was good—tannic and tart. A worthy reminder of many life lessons: a spindly trunk, and branches just laden with fruit.

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*This is a capsule version of his situation, written from my outsider’s perspective, and should—in fairness to his mom especially—be read and understood as such. No piece of writing, however careful, ever tells or ever can tell the full tale. Not that I was endeavoring to, clearly; but I’m conscious of taking a liberty when writing about anyone but myself, and it matters to me to note that, as a caveat.

**I can’t claim to have invented this awesome activity. I think it’s fairly common in the world of mindfulness, but I know that Susan Kaiser Greenland describes it nicely in her book, The Mindful Child.