Clinician Thoughts

It’s been a while. Yadda yadda yadda.

Won’t be cross-posting this to Facebook; this is mostly for me to write my current thoughts and handwriting will take too long and require too many hand cramps.

Today’s supervision topic was about how I was feeling with clients and work and if those feelings were a result of my becoming a better clinician, my feeling burnt out/jaded, and/or my feeling depressed. To be honest, I don’t think we found an answer and came to the conclusion it was probably a mixture of all three.

The first is that I was able to recognize how I was showing up in a session with a client and that I had acted in a childish manner (without the client knowing). Even though I knew I could get away with it (acting childish and the client not knowing), the fact that I knew I had acted in such a manner did not sit well with me.

The second is that I noticed I was offering to meet with clients less often or even offering them to discontinue therapy all together. I told myself it was because there wasn’t more for us to do in therapy, that the goals I wanted for them didn’t seem realistic and to be honest, weren’t really goals they had expressed themselves of wanting. Who was I to impose my wants into their treatment? Besides, they were stable and managing their basic needs. But then I started to wonder if I was pushing them away because I just didn’t want to work with them anymore, that I was too tired of trying to find a way to help them improve their quality of life (knowing full well that it would be with my idea of ‘quality’) when they just weren’t in a space to help themselves to do it. So why? Why keep trying? And why was I moving into this frame of mind in the first place? Was I thinking like this because I had finally begun to realize that treatment goals in community mental health were much more basic than I had originally thought they were supposed to be?

And the final nail on the coffin is that I spent all of today in an irritable mood. I had slept enough the night before. I ate. I was hydrated. Yet I was so disconnected from everything that was occurring around me with no seemingly good reason why. Though to be honest, I had been feeling quite irritable at work for a few months now and thought it was just me finally wising up to all the shit that people did at work.

I still don’t know what’s going on. I hope this feeling is temporary. I know I can do a few things that will help and I also know I’m working on a few other interventions to see if that will make some difference. I won’t really know for sure but I guess first things first is that I need to start checking in with myself. I had missed all the signs that were indicators of my not feeling well (e.g. eating and craving more sweets, feeling more irritable at work and in life, etc.). As a colleague once told me, I need to be friends with my brain.

The Return of the Prodigal Son

The Wikipedia version

The TL;DR (too long; didn’t read) version of that parable is that there was a son who wanted his inheritance early. He squandered it away and went back to his father for forgiveness.

I share this parable to reflect and to acknowledge my good service today. One of my clients drew the parallel that they were the Prodigal Son and their inheritance was their relationship (or lack thereof) with their child. My client felt they lost their child due to their child’s refusal to have a relationship with my client. My client felt an immense sense of guilt for they felt that they had done something wrong to make that child go away, to become “lost.”

I chose one part of the parable to reframe today. I asked my client about the money the Son had squandered – where did it go? My client focused on the Son, telling me that the Son had lost the money and no longer had it. I asked again – Think outside of the Son – where did the money go? My client wasn’t following and was still focused on the Son and the Son’s actions.

I pointed out that the Son’s money left his possession but entered into others’ lives, that he paid for the services he rendered, the food he ate, the parties he threw. His money supported their businesses, their families, their services, their labor. While the Son may have “lost” his money, his money was still out there to serve another purpose. Yes, it was sad that the Son squandered his wealth, but the silver lining is that his money helped many others.

That’s what my client’s child was doing. While their child was not in their “possession,” they could still serve another purpose elsewhere. They were not lost, they were doing good work somewhere else. Watching my client’s face change as we made the connection was so rewarding. In that instant, in that moment, I was reminded of why I do what I do. I could see the wheels turning in my client’s head. That guilt my client felt was starting to lift – chip away little by little.

That moment when it clicked made everything worth it all.

Principles

n. a fundamental truth or proposition that serves as the foundation for a system of belief or behavior or for a chain of reasoning.

I have very strong principles, or at least I attempt to adhere to them quite strongly. When I fail to uphold them, I feel as if I have failed. That I am a part of that injustice against the world. Why should I benefit from one advantage? If I have spotted an advantage and I utilize it, how is that okay?

Am I paralyzed? Do I suffer from “analysis paralysis?” If so, how much of that phenomena takes a hold of my life?

Is there anyone who struggles like I struggle? Who lacks the same self-compassion that I lack? How are you supported? What keeps you held together?

I often wander between the space of too much and not enough. I struggle with the in between. If I turn in half-assed work, I belittle my achievements and never acknowledge that half of the work was at least completed. Because I can’t. Half-assed is practically no-assed work. How can I allow my reputation as this “bright” and “smart” individual be marred by this piece of work? How can allow myself to accept something so shoddy?

If I am going to commit, I must commit fully. What are these baby steps that I hope to instill in my clients? Do they believe me? I don’t believe me. Do they believe that I believe for them even when I don’t believe for me? Does it work like that? Can it work like that?

What is compassion? What is forgiveness? How do I do those things while not letting myself off the hook? Is there such a thing as a “Cheat day?” Can I survive with a “Cheat day?”

Reflections for March 2nd

*This is lengthy and really just typing this for my therapeutic benefit. I’m not even going back through to edit!

It’s so interesting to see the connections when I reexamine things. It’s like watching a movie several times and discovering something new each time. Yesterday, we had a discussion about my parents and some of the conflicts that may have occurred. It is very interesting to me to see how differently all three of us are despite the supposedly similar parenting we received.

As I contextualize it, I am starting to realize that’s actually not the case at all – that we all experienced our parents in the same way. Sister witnessed the struggles of being new immigrants and living the life in a low-income neighborhood. I imagine she may have developed a deeper appreciation and gratitude for the things that my parents had to do in order to provide for us. Brother missed out on almost all of that. He lived the life outside of the ‘hood. In my eyes I consider it spoiling, but perhaps it was really just finally having the luxury and privilege to buy their children the things they wanted instead of saying, “No, it costs to much” and just providing for the things that we needed. I saw a mix of that. I was shielded from the struggles of poverty being low-income. I knew we didn’t have a lot of money, but they provided enough so I didn’t need to want a whole lot more than what I had.

Once in a while, I think to myself that maybe I would have turned out to be a better person if I had seen, witnessed, or been a part of their struggle. Instead, I lived a sheltered and seemingly privileged life. I had enough food, clothes, activities. I never had to worry about if we would make rent, have enough food, or couldn’t afford something really basic. Anything that would be needed for my success, it was provided for and I took that for granted well into my early 20’s.

While I want to acknowledge their hard work and perseverance, Mother really did a number on me. I was always a Daddy’s girl and let’s be honest, I probably will be for a long time. Obviously, it’s quite subsided, but I will always connect better with him. And perhaps that’s what feeds into my struggles. My dad worked hard and I saw him briefly in the morning and when he would come home for dinner. Now, when I think about it, I think I wanted to be like him. I didn’t realize it at the time, but I’m starting to wonder if there’s that relationship.

He was a man of great morals. There was a right, a wrong, and a just-not-worth-the-effort. His morals were very clear.

If you worked hard, you would do well in life. You did not need to take advantage of others in order to become successful. You should be nice to others. If you can afford it, do a nice gesture. Make sure you greet your relatives with proper respect. Work first, play later. Anything you feel that you need, just ask. I still have the final say, but there’s a reason why I’m saying no.

I am ashamed to admit that it took so long for me to just realize how great of a man he is and how much shit he had to put up with when raising me. I was not the easiest child, and probably even now. Sure, for the most part, I was relatively well-behaved. I rarely, if ever, got in trouble with school teachers or administrators. I completed my work and aced many tests. But I was a bit of a tomboy. I chased the boys because they would pick on me (not in a bullying way – probably just doing it for fun and realizing that I would actually respond). I wasn’t (and still am not) a girly girl. Sure I liked dresses because they’re nice and cool, but I’m going to sit all prim and proper just to make sure it doesn’t get a little bit of dirt on it. I played with fire. I stole money from them. I lied often (mostly to avoid confrontation and/or spanking). I wanted to defy them and if they told me to do something, I wouldn’t want to do it right away (which drove Daddy nuts). I argued with them when I had to drop out of a semester from college. I went into consumer credit card debt and needed a bailout.

Like I said, I was difficult. But despite all of those things, no matter how many mistakes I made, the arguments I had with him, how I had resented him through my teenage years, he stood by me and loved me anyway. He rarely, if ever, called me names. He was and is, one of the truest definitions of unconditional love.

Mother, on the other hand… she’s… well, different. She is not who I aspire to be and yet, picked up on so many of her traits. I am easily irritable. When I was upset, I used to say whatever I was feeling at the time, even if that meant hurting someone else. I slammed doors (sometimes do), I cursed, I scowled, I once smashed my foot through a wall (didn’t realize it was such thin sheet wall!), etc. I have created more awareness and curbed it a lot, but there are often times when I allow myself to have unfiltered anger (at least I’m choosing to be angry now). She shoplift(ed) and while I knew it wasn’t okay (Daddy’s ethics), I wanted things anyway and it appeared to be a victimless crime, right? She hoards. “One day I’ll need it.” “You bought it, so you shouldn’t waste money.” “I’m going to give it to so and so.” Of course, that never happens and the amount of stuff just keeps piling and piling. I bought a bunch of Bath & Body Works’ hand soaps during college. 6 years later, I’m still not done going through all of the bottles. Yes, six years. It’s ridiculous.

So maybe those are some of the pieces that contributes to my lack of self compassion. Because I hold myself to the higher standard (Daddy) but tend to do things that aren’t going to follow those standards (Mother), I can only imagine all of unspoken stress and conflict I felt.

Darn. Want to write more, but apparently my eyes are droopy.

Empathy

n. the ability to understand and share the feelings of another.

Some of the great things about empathy is when it can lead to having compassion for others and to applying that in order to create a safe space for others. Empathy can help reduce arguments, create teachable moments for all ages, and build connections with others.

One of the downfalls of empathy is when there is a lack of boundaries. I suffer from that. It is very often that I will be so empathic towards others that I feel as if I have no course of action, or at least not a desirable one, because if I now choose what I would have wanted to do prior to having said empathy, there will be the additional feelings of guilt.

Very notably, I’ve seen this play out in my work with clients. They have helped me understand their symptoms – great! Then I notice myself wanting to support them in a way that I consider to be helpful, but in fact, really isn’t. A client who may have a drug addiction? I may not convey how serious their addiction is in fear of making them feel judged. A client who may be depressed and can’t attend sessions? I may let the lack of appointments slide.

As I continue to develop my clinical skills, which in turn help me develop my interpersonal skills, I know that there will be times when I will struggle with empathy and boundaries. I will need to decide when I can be empathic and how I can use that empathy for the benefit of my relationships and for clients’ progress.

It has been an interesting journey to uncover how much more complicated empathy can be. On the surface, it sounds as simple as just putting myself in others’ shoes. Below that, it’s so much more complex.

Head Space

Once in a while, or many whiles, our heads get into a funk. Mine gets into a funk. It’s sometimes hard to distinguish what’s a real funk and what’s a funk that I can push through. Are you close to the finish line and can muster up some strength to get you past it? Or are you lost somewhere on the trail and don’t know how much further away that line is?

Image from headspace.com
Image from headspace.com

It is a skill, a very important skill, to build some self-awareness and introspective skills to determine what the best course of action should or could be. There are days where I can see the finish line, but I’ve run out of the energy to run and push through. So I walk. It’s long, it’s slow, it’s not very comfortable, but I walk. I let myself feel all of those things until it changes at that finish line.

Image from headspace.com
Image from headspace.com

Some days, I just don’t know what to do. So I get scared. I get nervous. Then my head space gets really crowded. Everything starts to look murky and all of the doubts have started creeping in. They’ve busted through the doors and are having a party in my head. Those days are really hard to come out of. It takes a lot of energy and mental space to clean all of that mess up. What helps the most is when you have great resources in your life that can help you clean up and kick some of those doubts out of your head or make a plan to address them.

Sometimes I’ll think about what I can do differently the next time this happens. And sometimes, I just say that it’s part of the process of life and I keep on going to the next thing. The great thing about it is the ability to learn and grow from all the times my head space changes. Maybe the doubts will come back and maybe next time, I won’t need to panic when they do.

Waiting

Our anniversary is coming up and I was thinking of gifts to commemorate our time together. I thought about getting him a gift that would let him know that I would wait for him to be ready. Ready for what? For everything that social norms has been suggesting we do: settle down, get married, have kids, etc. Social norms (in a heteronormative world) also imply that women are much more likely to be “ready” for these next steps than men and more often than not, we women are “waiting” around for the men to “get their act together” to move into these next steps with us.

However, the more I thought about it, the more I realized I hated the idea of waiting. It’s not that I don’t want to wait and think I should find someone who won’t make me wait – it’s that I hate the connotation that “waiting” implies. That somehow I have the upper hand in the relationship, that there is a timeline to be met and someone is not meeting that timeline. In other contexts, sure – waiting is appropriate. In a relationship? There shouldn’t be a “waiting” in the sense that you want someone to “catch up” to you.

People ask us the very common, “When are you getting married?” At first, I would joke: “Well, that’s up to him. *nudge nudge*” After a few of those, I hated it because that meant I would put him on the spot, that I was placing pressure on him to do something he may or may not be ready to do. That didn’t sit well with me and I shouldn’t be throwing him under the bus when those questions arise. If anybody is doing any kind of “waiting” around, it should be the both of us, together. Both of us need to be ready, together, to move into whatever steps we want to move into. It shouldn’t be that one of us gets there first – we aren’t hiking. He isn’t 20 steps ahead while I huff and puff my way up the incline. That isn’t a relationship. That’s playing a game of “Who will get there first with me that I can tolerate?”

So I’m back to square one for gifts. Maybe we don’t need gifts. I know I don’t need one. Just like all the times I make comments about coworkers getting flowers delivered to them at the office. Sure, it would be nice to have, but in no way, shape or form, does his sending flowers to me make, break, or change our relationship. It’s nice to have, but I don’t need it. I need him and I would trade a million roses in the world if that meant I could get him next to me instead. But gifts are another topic for another day.

 

Kudos to me!

Recently, I had a client tell me how ze (gender neutral pronoun) applied some of the coping skills learned in therapy. I had to pinch myself to stop myself from feeling emotional because I was so happy for this client! This is a client that struggled a lot with worrying and overthinking. In our previous meetings, we discussed some “in the moment” (e.g. heightened emotions) and “out of the moment” (e.g. idly sitting, spending time with friends) skills ze could apply.

Ze shared an incident in which ze felt really panicked, but applied a technique we discussed which significantly reduced the duration of ze’s panic. Ze also mentioned a time in which ze had so many racing thoughts but was able to use a cognitive skill to come back from those thoughts.

It was absolutely amazing to sit across from ze and to hear about all the changes that happened. Ze also reconnected with someone who hadn’t seen ze prior to counseling and commented on how much ze had changed. It was an affirmation not only to ze and the work that ze has put into counseling, but I’ll admit it, it was an affirmation for me too, to know that I helped to support ze’s change.

So, times like these are the ones that keep me going when the going gets tough. [I’m looking at you documentation!]