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.