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Tuesday, August 23, 2011

A New Hope

A week from today I begin teaching an undergraduate psychology course. For the longest time, teaching at the college level has been a goal of mine, and now, that day is a lot closer than I expected it to be, and actually easier to get into than I thought. Turns out, full-time clinicians were being sought in my area for the clinical experience we bring to the classroom, just as I was seeking to expand my professional experience to teaching! It's one of those glorious marriages of goals that don't come along everyday. Now that the first cat is in the bag, I am starting to get nervous. A lot hinges on this plan- this is a stepping stone to the future for me, so I have to do a really good job if I want to keep teaching additional classes. Don't screw this up, self. I hope I do a good job! Eep!

Monday, August 22, 2011

Random Acts of Power

There are many, many things I wish were run differently in the bureaucratic system where I work. This is the nature of bureaucracies. It doesn't seem to matter which one you are apart of, the same sorts of problems persist.

           This inability to dictate how my day goes has been a source of frustration to me since...forever. "I don't like that policy," I say, and the answer, however nicely phrased, is "too bad, its a part of your job." And when people do try to make policy changes, things seem to have a way of drifting back to their original forms because people do their job the way they always have.

           So powerlessness is a feeling I grapple with each work day, and it can consume me up in frustration, irritation, anger, and hopelessness. None of which makes a productive employee. It makes a disgruntled employee.

           But this summer, when I was on a well-needed rest from work, I did a lot of praying and a lot of thinking. One of the revelations that resulted was this:

1. I have very little power over the bad things that happen where I work. It doesn't seem to matter what I do, they don't get fixed or changed by anything short of an act of God.
2. I have A LOT of power over the good things that happen where I work. It's much easier to make good happen than stop bad from happening! So a well-placed prayer/hug with a coworker, a treat for my office mates, a drop by and say hello to a lonely fellow employee- these things make the day much more palatable for myself and others, even if we can't seem to control the system which dictates our work day.

            I am sure there are bureaucratic gurus out there who know how to "fix" these things and make amazing, streamlined choices which benefit everyone by removing systemic problems. I am not currently one of these people.  But right this minute, right now, I have the skills to improve my working environment through addition rather than subtraction.

           So that is my new goal. And you know what? I don't feel so powerless anymore.

Monday, August 15, 2011

Removing the Fixings: Examining The Issues

     When I started my therapy career, if a family came in with a lot of emotion and upset, I would find myself disengaging because I couldn't immediately see a solution to their myriad of issues they were bringing to the table. It made me feel sick, powerless, fearful, and reluctant to see the clients who needed me the most because I couldn't figure out how to treat their dysfunction. One of the challenges of family therapy is having to listen to so many different people and formulate treatment from all their stuff that works for everybody, and some of my families are very vitriolic. In supervision, I came to realize I was practicing a slight form of dissociation when these families would come in that rendered me unhelpful. I felt the need to either better control the session with less talking time and more structured time, or to interrupt and redirect, or to just sit and glance up at the clock, hoping they would finish tirading soon so I could actually do some therapy. I felt embarrassed that I didn't have quick answers for them, and impatient if they didn't "get better" soon enough. I chalked all this up to not being the best therapist for the job, which sent me deeper into my disengagement. It didn't help that I was told to focus specifically on Solution Focused strategies with all my clients, no matter what, so I felt forced to stay in a little box of communication and try to remember all the catch phrases and questions I was "supposed" to ask instead of communicating naturally.

Over time, I have learned a few things. I'm excited because today I navigated a session that could have been uncomfortable because of its deep emotionalism and the family member's difficulties communicating with each other. But in the last 2 and a half years, some things are finally clicking for me. Many of my ideas are based on Solution Focused and Motivational Interviewing concepts, with an odd hybrid of Psychodynamic and Attachment Theories thrown in, so you will see those theories demonstrated in what I have learned. I know more experienced therapists than myself have said these things, and said them better, but here is the way I have it worked them in my brain.

1. Treat all issues with genuine curiosity instead of trying to find a solution right away. Spend more time analyzing and less time intervening. What I have found this accomplishes is that interventions rise to mind based on analysis that I might never have come up with otherwise.

2. Treat all interventions as experiments, and all analysis as a hypothesis. This one I borrowed from our wise Solution-Focused gurus, but now I am actually doing is a lot more than I used to. Maybe I am right, or maybe I am wrong. Lets see, shall we? "What if we tried...could that help? What do you think?"

3. Reserve the right to be WRONG. I can be wrong a whole lot more than I can be right, and how I see a family when I first assess them may be totally different than I see them 6 months later. I routinely change my analysis. I used to feel bad about this, like I wasn't a good enough assessor, but now I am learning that most of it is based on the information I have been given, not on my skills. I am bound to get something right eventually, and its usually sooner than later as long as I keep communicating my hypotheses to the family and let them correct me or modify my understanding as needed.

4. Let the problem be a big problem. A problem neither needs minimization or exaggeration. It is usually exactly as big as the family thinks it is and they know better than me. While I normalize a lot, especially about what to expect from teenagers, who are apparently the most obtuse creatures on the planet, I also respect the level of distress the issues facing the family are causing for its members. I am also learning I don't have to resolve their problems in the session in which those issues are uncovered. I can respect their problems and let them leave with the family without being an ineffective therapist. Rather, its a recognition of the seriousness of their situation that they had to come and see a person like me in the first place. Their problems are big problems, or they wouldn't be here. I am learning to be okay with complex problems which aren't fixed in one or two sessions.

5. My most important job is to care for 50 minutes. People may not remember how I analyzed their problems or my interventions, but they will remember that I care. I am striving to be an excellent therapist, but what matters to be an adequate therapist is simply that I know about their lives and show them compassion and love. I am also learning how to share with them emotionally, and then let their feelings go until the next time. It has taken some mental work, but I am learning to put my emotional response to their emotional displays away until they are needed again. Sometimes residual responses remain is particularly troubling, but most of the time I can pick up and put back on my mantle as needed. This is going to continue to take some work on my part.

What about you? What lessons have you learned in treatment, or in your job, which someone may have told you about but didn't start clicking until you were practicing for a while?


Wednesday, August 10, 2011

Blog me This

I attended an orientation last night for the university I will be teaching a course for this fall (about which I am SUPER EXCITED). At this orientation, one of the other professors mentioned an ethics conference he attended where the therapists and other helping professionals were encouraged to get rid of any social networking pages or other forms of public identity online because of how the finding of this information might affect the clients. He said there was a case recently of a therapist whose license was revoked because her client (who Googled her) found her Facebook profile and, after seeing a picture of her in a bathing suit, felt this changed the dynamics of their relationship and impaired his therapy.

We could focus all day on the reasons this wasn't really the therapist's fault, as he had gone out his way to look for information about her that she did not volunteer, and so on, but the point is that the committee ruled the burden was on her, and was encouraging all helping professionals to steer clear of social networking internet activity.

Which leads me to a lack of cultural understanding directed by older clinicians toward younger clinicians. I am 27. I keep track of everyone via Facebook. I mean everyone. My grandma is on Facebook. I followed the play by play of my niece's birth on Facebook. I don't get people's email addresses or phone numbers if I want to stay in contact; instead I ask, "Are you on Facebook?" And they usually are. To ask me to get rid of my Facebook is like asking me to cut contact with all the people I have ever known who I don't currently see. In fact, the recent dilemma is whether Google+ is going to be something I need to invest time into or whether I can just keep things how they are.

Social networking is also a way to present myself publicly in an effective way. It doesn't bother me that potential employers might look me up- I welcome it because I make sure my social networking face is professional and appropriate.

I understand the need for discretion and not allowing just anybody to see photos and personal information. I have appropriate blocks on my Facebook to ensure privacy and make sure not to post anything too personal.

So I found this declaration to avoid social networking as distressing and somewhat insensitive to a generation that relies on the internet to keep track of people throughout their lifetimes.

What are your thoughts on this? Do helping professionals have the right to personal social networking? Or ought we to be ethically bound to internet silence for the sake of our clients?

To add to the discussion on the topic of social networking, head over to The Strangest Situation for information from the same conference as it relates to teenagers.