Saturday, December 3, 2016

Light in the darkness...

Where do we find out light in the time of darkness?



This week has been an emotional ride for me as a therapist and a human. My schedule is packed. I start my days at 8 am and often don't leave until after 6:30 pm. But that's ok for now. It will thin out after the Holidays I am sure.

This week I saw a young man whom I hadn't seen for a few months. When he first became my patient, he was seeking insight into how he could improve his well being. He has an extensive trauma history (as do many of my patients) and had isolated himself from relationships other than work related ones.

He appeared on my schedule as an "emergency appointment". When he came in, he looked defeated.
He told me he had tried to commit suicide 2 days previously. There was a long involved story that led to his being so in pain, so tired, so defeated, that he decided to end it all. But in those final seconds, he sought intervention, called a friend who called 911 and got him to the ER where they took over...

He sat before me and I thought of others in my life who had been in his place. I have several friends and family members, past and present, who have attempted to kill themselves. I have never been in that spot so there is much I don't understand, but I do know that there can be pain so deep, that death seems like the only answer. I know I cannot save someone if they choose to end their life. I have learned through experience that choice is theirs alone and I cannot carry the blame for their actions.
I can be angry, sad and grieve but I cannot carry the weight of their personal darkness.

I can listen, be present, try to help them discover reasons to live, try to find healthier ways to ease their pain and sorrow... but I cannot make their choice for them.

Do I feel helpless? Yes, at times I do.

So where do I find my light?

I have a great therapist who helps me find perspective. I have a strong connection with my family. I have great friends. I have my church family and my faith. I have my dogs and cats. I have connections filled with love. And for that I am so grateful.

I have learned to seek the light within myself. I have learned that healing happens.

This is what I sense most of my patients are missing and long for: connection. Finding unconditional love and acceptance from others and from themselves is often the missing piece of the puzzle. Often they have grown up believing they are not worthy of love. They have no role models of healthy relationships. They have no concept of their innate goodness and worth.

I have another patient who hasn't experienced abuse in his family but who was taunted and teased and firmly believes no one will ever love him because he is "fat and ugly". He is a brilliant scholar, wise and insightful and empathetic. "But will anyone see that?" he asks.  I can't answer that question for him. I wish I could. I understand, to a degree, his struggle. I have always wished I was prettier, thinner, taller, etc. I have at times focused so much on my physical shortcomings that I failed to see my value as a person. I spent a long time in romantic relationships where I felt "not good enough"; where I felt put down, labeled as a bitch, always lacking in some way... it's taking me a long time to see myself otherwise, but I am getting there. So I am trying to use what I have learned to help others.

I want to be a light in the darkness. I want to share the light that others have shone me. I know that darkness can be overcome. It is not easy, it is not quick, but it can be done.


Tuesday, November 29, 2016

Suck a little less each day...



I went to a training where the therapist said his goal was not perfection but "to suck a little less each day".

That has become my motto of late.

Some days I feel so out of my league, so lacking in skills, so helpless. I see people who have experienced so much trauma, so much pain, grief, fear, shame and loss that I don't see how they are standing.

Some days I feel that all I accomplish is just listening and passing them tissues.

Some days I provide them with handouts about how to cope. I coach them in deep breathing and other stress reduction techniques and give them tips on what worked for me and others.

But some days I feel like I fail them. Some days I feel like I haven't a clue on what I am doing, if it helps, if it even matters...

Today I saw a young man who was a kid 10 years ago when I worked with his older siblings. He was severely abused as a child. He was removed from his dysfunctional biological family and adopted with all his siblings. But too much had happened to them all by the time I met them. He grew up in a house of chaos. His older siblings are now very troubled adults. His mother brought him in hoping I could help. I had mixed feelings. I felt that if I could not save his siblings, what could I possibly do to help him? But we talked, we made a plan and I said yes to working with him.

His session was bookended by 2 other patients. One was a woman my age who had grown up a county over from where I grew up. She had grown up abused and misused. She developed a drug addiction, was arrested and spent time in jail. She is now on probation with a felony charge. We talked about her anxiety and depression. We talked about her goals. She smiled often her face lit up  by hope. I gave my standard speech about how if I am not the right therapist for her, I don't take it personally and will help her find the right one. "Oh no, you are the one" she said and she hugged me on the way out the door.

The last appointment was again a woman near my age. I had seen her for an initial session a month ago, for anxiety and depression. She had a long commute to work. She found that she got angry and anxious coming and going to her job. We talked about ways to relax. We practiced deep breathing and I gave her a stack of my "psychoeducational handouts" that are part and parcel of how I practice.
I always wonder if people ever read them, if they are helpful and if I should even bother giving them out.
Today she told me she had read them all and was practicing some of the skills in the handouts. She told me that was the most useful thing any therapist had ever given her. She talked to me about how at ease she felt with me. She said she felt she was in a really good space.

So I asked: Did she need therapy to continue? And if so how frequently? Which led to the discussion of termination. She told me she felt like she could be fine but could she call if she needed to come back?
"Absolutely!" I said.
"Well then" she said, "I think I can make it through the rest of the year knowing that the door is always open here." And then she hugged me.

As for today, I do feel like a sucked a little less...

Sunday, November 20, 2016

The week after election, full moon with holidays looming...





What a week!

I saw 28 patients and only had to send one to the ER for suicidal ideation.

Talked quite a few down; lots of assessments on the fly with the docs this week.

I passed out tissues, listened and tried to help in any way I could.

I went out to dinner with a trusted friend on Friday and we consumed large glasses of wine and just talked for over 3 hours... vicarious trauma is a workplace hazard for real.

This election has brought up so much fear, and unfortunately it is not paranoia or imagined. There are steadfast concerns about health care, both physical and mental.

Several patients are gay and are wondering if their legal marriages will be anulled... several are people of color and worry about hate crimes... some are Muslim and fear religious persecution... the list goes on and on and on.

All I can do sometimes is offer a safe space in an increasingly unsafe world. All I can do is listen and pass them tissues. All I can do is to keep my heart soft and hopeful.

When asked how I cope, I told one patient that people like her give me hope. I see the best and worst in the world, I hear tales of abuse and neglect but out of that pain comes hope, forgiveness and healing... THAT is what keeps me going. Knowing that despite all that happens, there is always HOPE, there is always the promise of healing.

The World is a broken place but the cracks let the light in.


There is a balm in Gilead
To make the wounded whole
There is a balm in Gilead
To heal the sin-sick soul

Sometimes I feel discouraged
And leave my fear away
In prayers the Holy Spirit
Revives my soul again

There is a balm in Gilead
To make the wounded whole
There is a balm in Gilead
To heal the sin-sick soul

Take the time to be gentle with yourself, love your family, pet your dogs and cats... pray, rest and then dare to hope and fight for a kinder world.


Saturday, November 12, 2016

Election week and a full moon to come

So much anxiety this week.

I admit I awoke at 3 am on Election night, checked the results and felt my heart speed up and my stomach clench.

I knew the morning would be rough.

I work with in a great place. I love my job. It is a great fit for me. I see the world come through my door.

I have patients who are Muslim, Gay, Transgendered, Black, White, Asian, Nepalese, young, old and in between. I don't see a lot of rich white males though. I see the people on the fringes and in the middle.

I work with medical residents, young docs just starting out. And I am discovering they are not jaded, they are compassionate and caring and want to change the world too. Several pulled me aside and jokingly said, "I need a session with you". Half in jest, totally in truth?

Over the course of the week I have come to terms with the election. Honestly, I was a Bernie fan, but for me it came down to the lesser of two evils.

This week I have seen many posts on Facebook; many opinions, fears and anxieties, grief and anger reign...

So I have been thinking what I can do. I emailed a friend the following:

"So if my schedule for next week is indicative of the current state of the nation, I have 38 pts scheduled. Overwhelmingly anxiety diagnoses.
My normal schedule is 25. I opened up my ad min day due to the holidays approaching but did I expect this many patients? No. Do I think they will all show up? No. But the fact they scheduled shows the need and despair.
I have had several of the staff (docs, nurses) joking they need a session with me this week.

Our clinic sees a very diverse population. I have patients who are Muslim, Trans, Gay, Black, Asian, Nepalese... you name it, they come through my door. Except rich white men. I don't seem to have those appearing on my schedule...

It's a scary time. I do take hope in that there are many here who are fighting the good fight. Trying to improve the lives and wellbeing of the disenfranchised.

We have clinics specifically for LGBT needs, we have clinics for substance abuse, we are trying to meet overwhelming needs... but we are trying. So I will do what I can, when I can, where I can and this small blue dot will keep hoping for a better world.

I love you buddy. Stay safe."

I know he can take care of himself, but there are many in the world who can't. I realized I have to advocate for them. I may not be able to make huge changes in the world, but an hour at a time, a person at a time, I can give them a safe place. I can let them vent, cry, grieve as needed. I can pass out tissues, I can coach them in deep breathing, I can help them make a plan. I can help them sort out their feelings. It may not be much, but change is incremental and it's a start. 

I won't lose hope. I will not stop being kind. I will not stop helping others. I won't let an election change my values and my purpose which is to serve others and love the best I can. 

I know I am not alone in this fight. I know too many good people. I see them come through my door. I see them healing and fighting and hoping.

I still believe that there are more good people in the world than we realize. They don't make the news, they do their work quietly and gently. But they are there. 

No one is going to steal my hope. No one.

Saturday, October 29, 2016

Countertransference

coun·ter·trans·fer·ence
ˌkountərˌtransˈfərəns,-ˌtranz-/
noun
PSYCHOANALYSIS
  1. the emotional reaction of the analyst to the subject's contribution.


As a therapist I have experienced countertransference many times. Most people assume it is a negative reaction to  a patient... and sometimes it can be, but also it can be an overwhelming rush of empathy.

I have several patients who tug my heart strings and leave me thinking of them at random times. I do keep boundaries in place and I am self aware, but in the end, I am human...

Yesterday a young man sat in my consult room weeping. He reminds me a bit of my nephew, similar features, similar background, similar upbringing...
This is a young man working on his masters, who has an incredible vocabulary, comes off as intelligent and self aware, exhibits strong values, but has had his heart broken by the world.

He feels he is "not good enough" because a woman toyed with him, used him and then cruelly dumped him. He insists if he were 6' tall, blue eyed and blond she would love him... He hates himself, he says. He feels betrayed by his brother too... he loves his family but honestly when he talks about his brother, his brother sounds like a spoiled brat who also takes advantage of this guy. We are working on boundaries and self esteem. He is a sweet man but many will not look past the exterior to see that. 

Another patient, an older female, comes in and is visibly nervous, shaking, eyes darting around. The student shadowing me conducts one of the screens I use to determine diagnosis. I review it and talk to the woman about how she is showing signs of depression and anxiety, but given the history we just took, it appears situational. So how can we help? We talk about case management and put some resources into place. She bursts into tears. I ask what are the tears about? She replies, she was scared that I would put her in a "padded cell and tell me I am crazy". She states she didn't realize that we could help in so many ways. My heart breaks for her, she is so grateful and relieved to discover that she is "not crazy after all".

They come in and out of my door, the broken and wounded. My time with them is short. I often pray during the session "God help me help them". And I believe he does...

I can see how everything that has happened in my life has prepared me for this job. How all the pain, all the joy has enabled me to feel along with the patients. How it has broken open my heart so I can find something to love in them all. 

I do have countertransference, I do love them. I can't save them all, but I can love them...

Saturday, October 15, 2016

Grateful

 I awoke to 2 cats sitting on my chest staring at me... the food bowl was indeed empty so they were on the brink of starvation. I had to laugh at their tiny serious faces.

Next up were the dogs. After feeding and treats and meds I ended up with about 150 pounds of dog in my lap alternately kissing me and cleaning each other's ears.

Starting the day with strong coffee and animal antics is an antidote to the stressful week I have left behind.

I am so grateful for these whackadoodle fur faces.











Friday, October 14, 2016

Just another week
























21 patients... 1 crisis... calming staff... checking in... checking out...

"He had his knee on my throat trying to kill me... then he raped me."

"I don't know if I believe in God anymore. It all feels fake... like I was lied to."

"They just see me as V from the wrong side of the tracks... Old V with the drunk ass son..."

" I don't know who I am anymore. I lost "me" somewhere."



So much pain in such a broken world. I pass out tissues, I listen as they pour out their hearts, share their secrets and release their pain.

I see them at their worst and at their best. They are there in that small room with me because they want to change, because they haven't lost all hope, because they are fighting their demons to survive...

It's a sacred time, a sacred space. I sit and often I pray "God help me help them".

I want to save them all. I want to heal them. I want to love them all back to safety and sanity.  I want them to know that they matter, that their words are heard, that their lives have meaning.

Some days I leave exhausted. Some days I am on the verge of crying but suck it up because it's not about me, it's about them. Some days I arrive in the dark and leave in the dark. Some days I feel like I make a difference. Some days I feel like I have helped. Some days I leave feeling hopeful...


"I feel better. I am not crying everyday."

"I feel hopeful"

"I am 90 days sober."

"I haven't had a panic attack in 3 weeks." 

"I am happier than I have ever been..." 


Saturday, September 24, 2016

Colorado

I spent a week in Colorado with my brother at the start of September.
It is hard to describe the grandeur and intimacy that I experienced with Nature.  It ranged from high craggy mountains to the tiniest most delicate flowers... pictures don't do it justice but I will post a few!







Happy...

Mushrooming!



Rio, the new addition to the family...






Feeling strong and empowered!


The Aspens were just starting to turn in the high country!



"Follow me" he says....


Old Steam engine in the middle of mining country.

The Spruce Beetle has decimated the evergreen forests...

One of the best days of my life! I learned to ride an ATV and lived to tell the tale!







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