HAIL-MARY SWISH

There’s a basketball rim behind the agency that stands several feet below regulation. It’s supported by a plastic base that tends to fill with water, broken glass, and cigarette butts. The court is smaller than your kitchen, unless your kitchen is a galley on a boat; it’s made of brick and weeds and bordered by abandoned patio furniture. Beyond that, the miracle of grass.

It’s good for little but playing H-O-R-S-E, which I’ve done in blazing sun, swarms of gnats, and even cold, though not lately—it’s probably been twelve months or more since I’ve taken clients there. Different clients, different interests. My basketball, bought four years ago for work, sits deflating under the desk where I sit typing copious notes, community mental health’s Sisyphean task.

I don’t miss those outside sessions, which always made me feel like I was in the wrong place, wishing I were in the right one. I’m still working out to this day where exactly that place will prove to be, ultimately. I do sometimes, though, think about a middle school boy I saw early in my employment. He was my first truly mandated client and engaged in selective mutism in protest of his mother’s insistence that he attend therapy. The substance of her concern was his childish behaviors at home. I would not be of help, it soon became clear.

Our therapeutic relationship didn’t start strong. The boy complied with an expressive activity straight from a textbook, to choose an animal figure from a jar to represent each member of his family and place them in a constellation of sorts on a labeled paper; but his reasons for choosing each, he kept to himself.

It didn’t finish strong, either; our last visits, as I recall, surpassed mere silence and exceeded recalcitrance to enter territory beyond. While now I might recommend more co-parenting work, at that point on my learning curve, I was advocating to end services, expressing privately to my client’s mom that I would rather he feel supported in his preference than be turned off to therapy for the rest of his life. By then, she and I had had a few one-on-one talks, and I believe the most difficult piece about closing, from her perspective, may have been the loss of someone to hear her own challenges and frustrations with the whole family.

Formal activities work for some kids, but it didn’t take long before my focus shifted, for the duration of the middle phase, to attempting rapport by joining my client in whatever fun could be had. We played War (for the record, the most tedious card game I know) and UNO. There may have been an occasion of popping matchbox cars in a wordless contest; that’s a bit foggy now. Sometimes we went out back to the sorry court described above, clouds passing overhead. I had the idea that if I could impress him with my hoop-shooting skills, the energy of our visits overall might shift. Well, you already know that didn’t happen. But there was one glorious afternoon that lives in my memory…

His younger brother had come along that day, and the decision was made to head for the grass with a small finned foam football that was meant to have good spin, though not when thrown by my hands. My client was animated with unusual verve, in the role of leader. He talked! Mostly to his brother, but still! In a spirit of inspiration and delight, I proposed rules. Instead of just passing and catching or fumbling, whoever dropped the ball would run prescribed laps and then throw the football through the basketball hoop. If a basket was made, play could resume. If not, more laps.

He wasn’t just game, he showed gusto, and the three of us ran around the broken picnic tables until I literally, if dramatically, fell down panting. I think of that day, and the neon-green torpedo catching net, as my Hail-Mary Swish. I gave it my all, and my all was both grounded and free. If my client remembers anything from our time together—ancient history now, in kid years—I hope that’s it. We salvaged something, I think, however small. Not in that case, but in the very best cases, salvage can be salvation.

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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.

 

 

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.

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.

WORK-LIFE RESONANCE

 

I recently sat in on my first Aikido class. Afterward, I was pleased to tell acquaintances that I now know how to throw a grown man to the ground. That was just silly bravado for my own amusement, however, and not at all reflective of the discipline. What you learn in Aikido, as the sensei put it, is how to help someone fall.

That concept speaks to my sense of the work I do.

Vulnerability tops nobody’s list of favorite mammalian sensations; certainly it doesn’t top my own. For me, the experience of vulnerability can evoke fight, flight, and freeze simultaneously, an anti-trifecta. So I empathize with those who are ambivalent about therapy, instinctively resistant to the deeper conversations.

My faith in the depths is firm; my compass points inward. But the “fall” into therapy has to be taken with great care and companionship, and one of the best ways to achieve that—in addition to active listening and the sensitive use of silence—is through reflective statements. Not a flurry of questions, chop-chop-chop like karate. Minimal use of questions, maximal use of restatement, summary, and gentle extrapolation, always open to correction.

This approach is beautifully described and detailed in Miller and Rollnick’s Motivational Interviewing, one of the most inspiring texts of my education. MI is the Aikido of therapy! It’s rewarding to work in such an intentional way, to assist the fall—and the standing back up.

I was sitting with a traumatized tween girl on the floor in my office. Her chaotic life experiences were poignantly evoked by the careful way she organized my dollhouse, visit after visit, arranging everything just so. One particular afternoon, she was highly escalated from the car ride to the appointment; she had shared information about her trauma with her mother, and her mother had gotten angry.

My dollhouse is an eco-friendly Scandinavian wooden “chalet” that can be separated into two parts. For the first time, the girl separated them and set one part off at a distance: “This needs to be its own house.” Sometimes that’s what’s needed, I said.

She described to me the conversation in the car as she worked on one house. I continued to reflect and validate what I heard her say. After a while, I asked her permission to share a thought I had. She granted it, and I proposed that her mother may have been too upset to give her the response she needed, but that we could try again to talk all three together when things were calmer.

She reached for the “other” house, saying, “I guess this actually belongs here,” and put them back together again, making a new space of the whole. And she started, for the first time, to tell me the story of her trauma, using the dolls and furniture as props to her narration. When her mother joined us, they were calm together. The work continued, and the work began.

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Monday I had my four-year anniversary with this site! 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.

 

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.