It was an emotionally challenging day at work today. Patient number one was getting ready to discharge today. Treatment was successfully completed. Vivitrol administered. Prescriptions filled out. Doctor seen. IOP set up. Then, as she waited for her parents to pick her up I received a call telling me her probation officer was in the lobby with an arrest warrant. An arrest warrant for a possession charge. I went to the female building and braced her for the events that would be shortly unfolding. I had her call her parents. I copied two sets of discharge paperwork including completion certificate. I got two envelops and place a copy of each set of paperwork in each. I packed one envelop with her things since her parents will be coming to pick her stuff up then I walked her over to the lobby with another set of paperwork to give to the probation officer as proof that she successfully completed an inpatient program and received the Vivitrol injection. They handcuffed her and shackled her which I personally thought was "overkill" for the charge. I talked her threw the ordeal and walked with them to the car.
I work in a profession where 90% of the patients I encounter have some sort of legal involvement as a result of substance abuse. I speak with more probation/parole officers, judges, attorneys and DA's than I could ever count in all different counties/cities throughout the state of Pennsylvania. Honestly, I feel like I am an attorney myself at times. Advocating for people is very much like an attorney. You should see the arguments I prepare to get patients more inpatient time from insurance companies. This profession is not for the faint of heart and one better know how to speak and write because one does a hell of a lot of it everyday. Whatever happened to the days where a patient laid on a couch talking while the therapist listened and never said a word. Yeah. That kind of therapy does not exist anymore. Today, therapy is advocating, teaching. doing case management while helping someone cope with their substance abuse, mental health, legal and family issues. It is about finding someone a safe place to live dealing with DHS or CYS workers conducting family session and teaching family education. It is about court continuous, visitation, trauma, educational and employment issues. It is about paying an overdue bill or applying for food stamps. It is about finding peer or recovery support. It is about every part of a patient's emotional, physical and spiritual health.
I believe a good counselor can balance it all and still have compassion and empathy. So many counselors burn out or get jaded in this field because the success rate is low and the relapse rate is high and the work is exhausting both mentally and physically. I personally believe it is the best profession in the world. Maybe that is why I am still working at it years later to the point where some of my coworkers who have not been in the field very long ask me how I manage to still be doing this type of work when in fact they are burning out. The only answer I can come up with is the love I have for the work and the fact that some people have gone through terrible things and if they survive the perils of their existence and land at my door step then I am going to help them with my best effort. I firmly believe in HOPE.
Showing posts with label counselor. Show all posts
Showing posts with label counselor. Show all posts
Wednesday, March 22, 2017
Wednesday, January 04, 2017
A Day in the Life of a Drug & Alcohol/Mental Health Therapist
So far this week I have gone into work early and left late. It has been an emotionally exhausting week thus far. The last four new patients on my caseload were admitted after they survived an overdose when given Narcan. These are young people and our state especially the city of Philadelphia is in crisis as folks are dying everyday from overdoses. It is clearly an opiate epidemic and myself as well as the other counselors have been working tirelessly to help but we are human too and the emotional toll it is taken on us is very real. Imagine having a job where the success rate is low and the death rate is high.
Tuesday, January 03, 2017
A Day in the Life of a Therapist
That moment when you realize you have two Reese's peanut butter cups in your desk drawer and take them out to share with your patient after an intense therapy session.
Thursday, May 19, 2016
What Is Going On
I just finished reading "The Last Lecture" by Randy Paush and though the book was upbeat and positive I could not help but hear an under tone of narcissism in regards to this man and the way he spoke. It was a quick read. I read it in two nights. It appears I can go through at least two books a week. It appears the more I read the more I want to read. I did enjoy America's First Daughter. It was well written and very interesting. Though the book was about Martha "Patsy" Jefferson Randolph, the book took in account the history of the era including how women were viewed in general. Reading the "The Last Lecture" was kind of a let down after being so absorbed in America's First Daughter.
Aubree has been really sick the last few days. She was running a high fever then broke out with blisters covering her body including inside her mouth. She has been extremely uncomfortable which resulted into two sleepless nights for her and her parents. In the meantime, I had ordered her a Minnie Mouse Car Seat (She loves Minnie Mouse) and it arrived yesterday. I hope it will bring a smile to her face. The doctor told Josh & Lynee that Aubree had a virus and the virus had to run its course. The pharmacy did make up a special mouth wash that numbs the inside of her mouth so she can get some relief. Hopefully, Aubree will be back to her "Happy Self" real soon.
Spoke to Joey today. I usually speak to him two or three times a week. He completed classes to be a "Peer Specialist" and he is working fulltime running groups and counseling. It is nice talking to your son about work as we can relate to the work we both do. Josh completed classes last Fall at Villanova and he is currently a Recovery Specialist. He will be sitting for his state boards sometime this summer. Shaun is a L&I Inspector for the City of Philadelphia. It appears the boys are all doing their own thing and making their way in this world. We have a new normal and I believe we are all working to acceptance of this new normal.
Speaking of work, I had a patient from Slovakia who had a translator during his entire inpatient stay. My first reaction and thought was "How am I going to be able to counsel through an interpreter"? It was a little strange in the beginning however as time went by I was really surprised how well we could work together through a translator. We had to bring in a Polish speaking interpreter as it was as close as we could come to the Slavic dialect. By the time, my patient discharged I was able to communicate with him through some of his words. It was an amazing experience for me as I could tell how he was feeling just by his body language and tone of voice even when I could not understand what he was saying in those rare times when the translator was not there. I am really grateful for the experience and he was an amazing kind man. I hope he does well in outpatient.
The weekend forecast is rain. It does not matter. We still are driving to the shore. I have not been down there in three weeks due to personal and work obligations and I need to get some things done down there this weekend. However, I would not mind some sunshine.
Aubree has been really sick the last few days. She was running a high fever then broke out with blisters covering her body including inside her mouth. She has been extremely uncomfortable which resulted into two sleepless nights for her and her parents. In the meantime, I had ordered her a Minnie Mouse Car Seat (She loves Minnie Mouse) and it arrived yesterday. I hope it will bring a smile to her face. The doctor told Josh & Lynee that Aubree had a virus and the virus had to run its course. The pharmacy did make up a special mouth wash that numbs the inside of her mouth so she can get some relief. Hopefully, Aubree will be back to her "Happy Self" real soon.
Spoke to Joey today. I usually speak to him two or three times a week. He completed classes to be a "Peer Specialist" and he is working fulltime running groups and counseling. It is nice talking to your son about work as we can relate to the work we both do. Josh completed classes last Fall at Villanova and he is currently a Recovery Specialist. He will be sitting for his state boards sometime this summer. Shaun is a L&I Inspector for the City of Philadelphia. It appears the boys are all doing their own thing and making their way in this world. We have a new normal and I believe we are all working to acceptance of this new normal.
Speaking of work, I had a patient from Slovakia who had a translator during his entire inpatient stay. My first reaction and thought was "How am I going to be able to counsel through an interpreter"? It was a little strange in the beginning however as time went by I was really surprised how well we could work together through a translator. We had to bring in a Polish speaking interpreter as it was as close as we could come to the Slavic dialect. By the time, my patient discharged I was able to communicate with him through some of his words. It was an amazing experience for me as I could tell how he was feeling just by his body language and tone of voice even when I could not understand what he was saying in those rare times when the translator was not there. I am really grateful for the experience and he was an amazing kind man. I hope he does well in outpatient.
The weekend forecast is rain. It does not matter. We still are driving to the shore. I have not been down there in three weeks due to personal and work obligations and I need to get some things done down there this weekend. However, I would not mind some sunshine.
Sunday, August 09, 2015
Integrity and Honesty
I have had my second cup of coffee on this early Sunday morning as I get ready to go to work. It is my weekend to be the onsite counselor and to teach classes in the Addicted Brain as well as Family education. The weekends can be exhausting as there is so much to do. I never minded working hard as I believe it is in my nature to do so and I do not mind the weekends so much as we (counselors) take turns rotating as the onsite counselor on the weekend responsible for every other counselor's patients in the event of crisis. There is much to be said for loving your profession no matter how taxing. This weekend I have been training a newly hired counselor. Since I am the one who developed the Family education program as well as the senior counselor, I generally train the newly hired counselors. I am a "rule follower" and very "organized" so I guess that helps as well.
Anyway, I like this new counselor. Naimah seems authentically sweet and kind hearted. I think I am a good judge of character and have the ability to conceptualize a person. I believe that is one reason I am a good therapist. I look beyond the surface of a person. Naimah seems to be a person of integrity and God knows we need more people in this world of integrity. There are so many dishonest people in the world who lack integrity and the sad thing is those same people think that others around them do not recognize that dishonesty. As far myself, I do not confront the dishonesty anymore as I believe it is a waste of my energy and my energy is sacred to me these days. I still believe most people are good however miss-directed they maybe on their journey in life. People are dishonest in a variety of ways be it a direct bold lie-in-the-face or an avoidance of following through.
I am unsure why I am thinking of integrity this morning. Maybe it is because of the political nonsense currently in the news or maybe it is my own experiences that I have lived through. I really do not know.
Let this be a Sunday of personal honesty and integrity.
Anyway, I like this new counselor. Naimah seems authentically sweet and kind hearted. I think I am a good judge of character and have the ability to conceptualize a person. I believe that is one reason I am a good therapist. I look beyond the surface of a person. Naimah seems to be a person of integrity and God knows we need more people in this world of integrity. There are so many dishonest people in the world who lack integrity and the sad thing is those same people think that others around them do not recognize that dishonesty. As far myself, I do not confront the dishonesty anymore as I believe it is a waste of my energy and my energy is sacred to me these days. I still believe most people are good however miss-directed they maybe on their journey in life. People are dishonest in a variety of ways be it a direct bold lie-in-the-face or an avoidance of following through.
I am unsure why I am thinking of integrity this morning. Maybe it is because of the political nonsense currently in the news or maybe it is my own experiences that I have lived through. I really do not know.
Let this be a Sunday of personal honesty and integrity.
Friday, July 31, 2015
In All Things Serious
It honestly feels great to be sitting here in bed drinking my coffee and writing a post after a crazy few weeks at work. I looked forward to this scheduled four day weekend and it finally arrived and I intend to enjoy every single moment of it. I love my work but sometimes I need a break from it. When I think about the craziness of some of those days I think to myself "I seriously cannot make up the shit I have seen or heard". Some of the things I was told over the last few weeks whether it was the excuse for leaving treatment against medical advice such as "I only came into treatment because my drug dealer was on vacation" to "I am going to "trick" on the avenue to buy footballs for my son's team" to "We were only fighting" when caught with one's pants off with another on top.
My background is in Human Behavior and that is exactly what I studied in college. Along the way, I gained certifications in Drug & Alcohol, Trauma Informed Care and various other sub-topics not to mention the twenty year background in the medical aspects of the human body. Bottom line is I have always worked in the Health Care Field whether it was addressing the physical or mental health of an individual.
I originally went to college back in 1978 for a degree in medical assistance. Once in the work force, I went back to college to pursue a degree in Laboratory Sciences. I then spent twenty years working in a Lab part time on the 2nd shift while my children were preschoolers and when my youngest child started first grade a position opened up for a first shift Lab Supervisor which I placed a request and was hired. I worked in that position for seven years until I was showing a new Phlebotomist how to do blood cultures on an eighty year old man in the CCU who spiked a fever and when I placed the needle in his arm (the trainee was holding the arm) the trainee let go and the man grabbed my arm and pulled me violently across him as the needle flew up in the air blood went everywhere as the bed rolled across the room because nursing forgot to set the brake on the bed.
The end result was a torn right shoulder (I am right handed) and the beginning of the end of that career. I continued to work but I needed surgery and that one surgery turned into three surgeries and chronic shoulder pain. At the same time I was dealing with one son in addiction. Another son joined the military immediately after the events of 9/11 and went off to war. My marriage of twenty three was ending. I was pretty stressed so I made the decision to do three things to help myself. I went to a therapist who specialized in Addiction. I started attending Al-Anon meetings. I decided to return to college and take an Addiction class to learn everything about what my son was going through. That one college class led into another and another and before I realized it I was on my way to a new degree and a new career. Three degrees later here I am.
I truly believe that "Where we are in life is exactly where we are suppose to be". Of course the unknown is frightening and when we are going through stress and pain, we do not understand or even want to feel those feelings however if I had not experienced all that I experienced in those years I would not be in a career I truly love and believe I am really good at. When you go to work everyday "loving" what you do, the days fly by and there is so much job satisfaction. I never felt that feeling in the twenty years at the Lab.
Some maybe thinking if I still believe that where we are in life is exactly where we are suppose to be after the events of the last four years which to all standards was far more tragic and stressful than anything else one can imagine. My answer is still "Yes". Addiction was not limited to one son and the addiction of another son and his girlfriend led to a tragedy of unbelievable proportions and consequences for all of us. We will never truly know what happened that night though I have my own thoughts on the matter as I reviewed the situation not from a place of emotion but a place of evidence of what I seen and heard. But as the mother of the accused I was never asked and when I tried to offer I was shut down by all parties involved including detectives, lawyers and courts. The point I am trying to make is "Yes" I believe those things happened for a reason though I rather wish the lessons could have been learned in a much different way. As a result a family lives without their son and a daughter lives without her father and her father's family including this grandmother writing this post. You can take the first part of that last statement two different ways.
Today, my sons are sober and have learned some difficult lessons. One son is going off to Villanova this Fall to become a Certified Recovery Specialist. The other son is working as a Peer Specialist helping other addicts whose crimes led to incarceration. Before that son went to prison I told him he had two choices. He can chose to get involved in the chaos of prison life by continuing to do drugs in prison and get into trouble or he can learn from his mistakes and become a better person. I told him that he will always have the love and support of his family. That being said, I told my son that anything we send him, he is to share among those who do not have any outside support. Every book I send him (he is an avid reader so I ship a dozen at a time) he is to pass out to others when he is done reading, He receives money on his books to buy things he needs to pay for medical and dental care and special treats/food and he is expected to share those things as well with others who have no support. Thus far he has chose to stay out of trouble so he resides in a dorm (much like as he did in the military) not a cell, took advantage of classes and is now working as a peer specialist who runs groups and is a mentor to other incarcerated addicts. He reads. Works outs. Plays softball and basketball. Officiates on the softball teams. He looks well. He sounds well. Is this what I wanted for his life? Of course not!. I do not believe any parent wants their child to learn lessons the hard way. My children seen to have to learn lessons the hard way and as a result it impacted the daily living of this mother in many ways. I became a counselor as the result of one son and a better counselor as the result of another son. I no longer take things or people for granted. There is very little that gets me upset these days because when you have experienced the worse nothing can compare to that feeling. I certainly do not care what anyone thinks about me and I do not feel as though I need to prove anything to anyone which is a significant change for a person who was a perfectionist in all things. I lost friends along the way and some family members. However, the true friends remained as well as the true family members. In a sense I am lucky that way because I got to see clearly who are true and loyal. Because I have experienced being in that very dark place, I can truly relate to those who struggle with or had struggled with depression.
Today, I view the world through a new set of lens and for that I am grateful.
My background is in Human Behavior and that is exactly what I studied in college. Along the way, I gained certifications in Drug & Alcohol, Trauma Informed Care and various other sub-topics not to mention the twenty year background in the medical aspects of the human body. Bottom line is I have always worked in the Health Care Field whether it was addressing the physical or mental health of an individual.
I originally went to college back in 1978 for a degree in medical assistance. Once in the work force, I went back to college to pursue a degree in Laboratory Sciences. I then spent twenty years working in a Lab part time on the 2nd shift while my children were preschoolers and when my youngest child started first grade a position opened up for a first shift Lab Supervisor which I placed a request and was hired. I worked in that position for seven years until I was showing a new Phlebotomist how to do blood cultures on an eighty year old man in the CCU who spiked a fever and when I placed the needle in his arm (the trainee was holding the arm) the trainee let go and the man grabbed my arm and pulled me violently across him as the needle flew up in the air blood went everywhere as the bed rolled across the room because nursing forgot to set the brake on the bed.
The end result was a torn right shoulder (I am right handed) and the beginning of the end of that career. I continued to work but I needed surgery and that one surgery turned into three surgeries and chronic shoulder pain. At the same time I was dealing with one son in addiction. Another son joined the military immediately after the events of 9/11 and went off to war. My marriage of twenty three was ending. I was pretty stressed so I made the decision to do three things to help myself. I went to a therapist who specialized in Addiction. I started attending Al-Anon meetings. I decided to return to college and take an Addiction class to learn everything about what my son was going through. That one college class led into another and another and before I realized it I was on my way to a new degree and a new career. Three degrees later here I am.
I truly believe that "Where we are in life is exactly where we are suppose to be". Of course the unknown is frightening and when we are going through stress and pain, we do not understand or even want to feel those feelings however if I had not experienced all that I experienced in those years I would not be in a career I truly love and believe I am really good at. When you go to work everyday "loving" what you do, the days fly by and there is so much job satisfaction. I never felt that feeling in the twenty years at the Lab.
Some maybe thinking if I still believe that where we are in life is exactly where we are suppose to be after the events of the last four years which to all standards was far more tragic and stressful than anything else one can imagine. My answer is still "Yes". Addiction was not limited to one son and the addiction of another son and his girlfriend led to a tragedy of unbelievable proportions and consequences for all of us. We will never truly know what happened that night though I have my own thoughts on the matter as I reviewed the situation not from a place of emotion but a place of evidence of what I seen and heard. But as the mother of the accused I was never asked and when I tried to offer I was shut down by all parties involved including detectives, lawyers and courts. The point I am trying to make is "Yes" I believe those things happened for a reason though I rather wish the lessons could have been learned in a much different way. As a result a family lives without their son and a daughter lives without her father and her father's family including this grandmother writing this post. You can take the first part of that last statement two different ways.
Today, my sons are sober and have learned some difficult lessons. One son is going off to Villanova this Fall to become a Certified Recovery Specialist. The other son is working as a Peer Specialist helping other addicts whose crimes led to incarceration. Before that son went to prison I told him he had two choices. He can chose to get involved in the chaos of prison life by continuing to do drugs in prison and get into trouble or he can learn from his mistakes and become a better person. I told him that he will always have the love and support of his family. That being said, I told my son that anything we send him, he is to share among those who do not have any outside support. Every book I send him (he is an avid reader so I ship a dozen at a time) he is to pass out to others when he is done reading, He receives money on his books to buy things he needs to pay for medical and dental care and special treats/food and he is expected to share those things as well with others who have no support. Thus far he has chose to stay out of trouble so he resides in a dorm (much like as he did in the military) not a cell, took advantage of classes and is now working as a peer specialist who runs groups and is a mentor to other incarcerated addicts. He reads. Works outs. Plays softball and basketball. Officiates on the softball teams. He looks well. He sounds well. Is this what I wanted for his life? Of course not!. I do not believe any parent wants their child to learn lessons the hard way. My children seen to have to learn lessons the hard way and as a result it impacted the daily living of this mother in many ways. I became a counselor as the result of one son and a better counselor as the result of another son. I no longer take things or people for granted. There is very little that gets me upset these days because when you have experienced the worse nothing can compare to that feeling. I certainly do not care what anyone thinks about me and I do not feel as though I need to prove anything to anyone which is a significant change for a person who was a perfectionist in all things. I lost friends along the way and some family members. However, the true friends remained as well as the true family members. In a sense I am lucky that way because I got to see clearly who are true and loyal. Because I have experienced being in that very dark place, I can truly relate to those who struggle with or had struggled with depression.
Today, I view the world through a new set of lens and for that I am grateful.
Saturday, July 11, 2015
In The News
It has been a long week at work. We are down two counselors. One counselor is on her honeymoon in South America and another counselor resigned to go back to school to get his second Master's Degree. I have been working long days. Thankfully, I love the work I do which makes it easier.
Josh is registered for classes at Villanova for the Fall. He has orientation the end of August. Josh is my late bloomer. However, it is never too late to return to school. I am evidence of that fact since I have three degrees. Speaking of which, I signed up for two classes myself at Bryn Mawr College for the Fall. I try to keep up with the latest developments in my field. Of course I need 25 credits per year to work @ FBHS and 40 credits every two years to keep my license to practice. I will be in school until I retire or die, whichever happens to come first:)
I started the 5th book in an eight book "Outlander" series called "The Fiery Cross" by Diana Gabaldon. Book four "Drums of Autumn" was the best book thus far so I could not wait to start book five. The series of Outlander books are nearly 90 or more chapters each so I generally read a different book in-between however book four was so good I skipped the in-between book to continue on. The series is as followed which I highly recommend if you have an interest in Scottish, English and American History with a little magic.
Shaun, Rita and the kids are arriving today at the shore. Though I am only staying until Sunday, they will be using the shore house until next Wednesday. Today, the community is celebrating "Halloween in Summer" with trick or treating and a kids' party at the clubhouse. The community has a lot of great activities for kids and adults alike. This is a great place for kids and I am happy my grandchildren are taking advantage of it. This house is my hideaway for peace and relaxation however this house is for the use of those I hold dear to my heart. Children should have a happy childhood filled with memories. It is an amazing feeling when we pull up to our house on a Friday evening and see the lights lit around our house with the wooded background and wet lands with the decorated lighthouse "light" lit in front rotating its warm light around the property. All the lights we installed this year work on solar power and are warm and inviting to the eye. We will BBQ this afternoon and have a fire tonight where we will all sit around talking. I noticed my parents' car in their driveway outside of their house so I suppose they came down. I know my sister will be down to her house with two of her four grandchildren later this afternoon. My parent's house is one block over whereas my sister's house is two blocks over the opposite way. We are all in the same community.
So there we have it., a post on the news.
Josh is registered for classes at Villanova for the Fall. He has orientation the end of August. Josh is my late bloomer. However, it is never too late to return to school. I am evidence of that fact since I have three degrees. Speaking of which, I signed up for two classes myself at Bryn Mawr College for the Fall. I try to keep up with the latest developments in my field. Of course I need 25 credits per year to work @ FBHS and 40 credits every two years to keep my license to practice. I will be in school until I retire or die, whichever happens to come first:)
I started the 5th book in an eight book "Outlander" series called "The Fiery Cross" by Diana Gabaldon. Book four "Drums of Autumn" was the best book thus far so I could not wait to start book five. The series of Outlander books are nearly 90 or more chapters each so I generally read a different book in-between however book four was so good I skipped the in-between book to continue on. The series is as followed which I highly recommend if you have an interest in Scottish, English and American History with a little magic.
- Outlander
- Dragonfly in Amber
- Voyager
- Drums of Autumn
- The Fiery Cross
- A Breathe of Snow and Ashes
- An Echo in the Bone
- Written in My Own Heart's Blood
Shaun, Rita and the kids are arriving today at the shore. Though I am only staying until Sunday, they will be using the shore house until next Wednesday. Today, the community is celebrating "Halloween in Summer" with trick or treating and a kids' party at the clubhouse. The community has a lot of great activities for kids and adults alike. This is a great place for kids and I am happy my grandchildren are taking advantage of it. This house is my hideaway for peace and relaxation however this house is for the use of those I hold dear to my heart. Children should have a happy childhood filled with memories. It is an amazing feeling when we pull up to our house on a Friday evening and see the lights lit around our house with the wooded background and wet lands with the decorated lighthouse "light" lit in front rotating its warm light around the property. All the lights we installed this year work on solar power and are warm and inviting to the eye. We will BBQ this afternoon and have a fire tonight where we will all sit around talking. I noticed my parents' car in their driveway outside of their house so I suppose they came down. I know my sister will be down to her house with two of her four grandchildren later this afternoon. My parent's house is one block over whereas my sister's house is two blocks over the opposite way. We are all in the same community.
So there we have it., a post on the news.
Wednesday, September 25, 2013
Journey of a Thousand Miles
The title says about everything I feel right now. I am at a stand still. I am not sure what to do or how to do it. What I do know is it cannot go on this way any longer. I need to reconcile myself over decisions others are making. I just do not know how to accomplish that.
It has been a busy couple of weeks with work, teaching and trainings. I have completed 24 out of 25 required educational hours for the year as per mandated by the state. I am going to do an online course for the last credit. I have completed courses in Neurobiology, Relapse Prevention, Cycles of Violence and Trauma. The state requires a lot of education per year and I am running out of places to take the classes as I do not want to repeat trainings but to discover new classes on subjects I am interested in.
Then there is work.
And my personal life.
Work keeps me going.
Home Life is so depressing and scary that I become overwhelmed with these sudden feelings of fear, I wonder if I will survive. At least the trauma trainings have taught relaxation techniques that I can use on myself as well as the patients I encounter. Daily readings, writing and music helps too. I am no longer in denial about whether or not he will go away but understand it is about the length of time, he will be away. He will probably never get married or have another child. He will have to change into someone he is not in order to survive the years ahead. The anger I feel must stay beneath the surface for as a witness, I know he is innocent and that someone else is guilty. However, that does not matter anymore to the people who are suppose to protect and serve. I will have my say. To that there will be no doubt. I will not just sit back and take it. I will speak but it is not the right time.
I have not seen her in almost three months and spoke via phone once since. I will not beg or plea anymore. It is what it is whether I like it, believe it is unfair and refuse to be blamed any longer. In the end, she loses out. I have a lot of love to give.
Then there is the feeling of God's cruelty. Place a little girl in my life for a short time then abruptly remove her. I am not sure what horrible sin I committed in my life that I deserved such a harsh punishment. And "no", I do not feel sorry for myself. I have done my best and that knowledge sustains me.
Like I mentioned, I walked a thousand miles and I expect to walk another thousand miles. Fear. Anger. Loss. Hurt. Sadness. Hope. They are just some of the emotions I have experienced thus far. I should add disappointment as well.
The bad news is I do not see an end in sight. The good news is I am dealing with it pretty well. Depression and anxiety have been kept at a distance not because of some magic pill but because of the way I chose to think and how I tapped into my own personal strengths. I look forward to a future though I am unsure how that future looks. I will see Ireland next year no matter what. I am determined to walk the paths of my ancestors and continue my genealogy journey.
This has been one hell of journey so far. I should write a book.
At least I got the title right when I created this blog though I should add Life is about the Journey.
Saturday, July 20, 2013
Compassion Fatigue
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Laura Simpson,Ph.D., is a Licensed Professional Counselor, National Certified Counselor, and Approved Clinical Supervisor. She currently serves an Assistant Professor of Counselor Education at Delta State University, as well as an active clinician. Her special interests include spirituality, secondary traumatic stress, supervision, and group work.
Donna Starkey, PhD, is a Licensed Professional Counselor, National Certified Counselor, and Approved Clinical Supervisor. She is currently employed as an Assistant Professor of Counselor Education at Delta State University in Cleveland, Mississippi. Her career experiences include counseling in a community mental health setting, serving as the counseling lab director in a university setting, private practice, teaching, and supervision of counselors for licensure.
As a career, counseling is recognized as emotionally demanding. Therapists are called upon to be empathic, understanding, and giving, yet they must control their own emotional needs and responsiveness in dealing with their clients. When engaging empathically with an adult or child who has been traumatized, clinicians are at risk of experiencing a state of emotional, mental, and physical exhaustion (Figley,1995; McCann & Pearlman, 1990; McCann & Saakvitne, 1995; & Pearlman & MacIan, 1995).
Empirical studies support the theory that counselors who work with the trauma of others have an increased likelihood of experiencing a change in their own psychological functioning (Chrestman, 1995). Reactions may include avoidance of the trauma, feelings of horror, guilt, rage, grief, detachment, or dread, and may possibly lead to burnout and countertransference. Additionally, these responses can impact the counseling relationship. If counselors are unaware of this stress response, they may implicitly convey a message to clients that they are unwilling to hear the details of the client’s trauma, or be less likely to ask questions to facilitate dialogue related to the event. This can result in a revictimization of individuals who often have limited environments in which telling their story is safe and acceptable (McCann & Perlman, 1990).
The effects of post traumatic stress disorder to the primary victims of trauma are well established. Of key importance to counseling practitioners is the examination of the effects that working with the primary victims of trauma can have on the psychological well-being of the counseling professionals. These ancillary effects, frequently experienced by those not directly traumatized are often defined as secondary trauma or compassion fatigue.
CF is defined as “a state of exhaustion and dysfunction – biologically, psychologically, and socially – as a result of prolonged exposure to compassion stress” (Figley, 1995, p. 253). CF is “identical to secondary traumatic stress disorder (STSD) and is the equivalent of PTSD” (Figley, 1995, p. xv). Within professional literature, compassion fatigue is also known as secondary traumatization, secondary traumatic stress disorder, or vicarious traumatization ( Figley, 1995; McCann & Saakvitne, 1995). Researchers in this area may differ in their focus or what term they use to describe the phenomenon, but one common theme emerges; work that is focused on the relief of clients’ emotional suffering typically results in the absorption of information about human suffering (Figley, 1995). Individuals differ in their responses to stressors; some are able to tolerate exposure to stressors without negative manifestations while others are not. Differences in coping techniques to handle stressors can play an important role in compassion fatigue.
Research has identified a counselor’s psychological well being as a contributing factor in the avoidance of compassion fatigue symptoms (Figley, 1995). When considering what makes up psychological well being, the issue of spirituality is of key interest. Graham, Furr, Flowers, and Burke (2001) reported on a survey conducted by the American Counseling Association that indicates counselors view spirituality as an important component of mental health. These authors conducted additional research that examined the relationship between religion and spirituality in coping with stress and found a positive correlation between spiritual health and immunity to stressful situations (Graham et al., 2001).
Spirituality and Wellness
Religion and spirituality has been increasingly supported as relevant to both physical and mental health. When spiritual and religious involvements have been measured, they have consistently been found to be positively related to health and inversely related to physical disorders, mental disorders, and substance use disorders (Cooper, 2003). Theologians and researchers alike agree upon one thing; spirituality is not the same thing as religion. Although they share common ground, they are distinctly separate. Spirituality is fundamental to understanding the ways in which a person finds purpose in life. It is thus a unique, personally meaningful experience, which is positively related to religiosity but is not reliant on any given form of religion.
A growing body of research has investigated the relationship of various spiritual principles to multiple aspects of health. According to Simpson (2005), cumulative reviews of studies have concluded that there is a protective factor of spirituality to health. Similar results have been found relative to mental health as spirituality has been associated with higher self-esteem and lower depression (Koenig, 1998). According to Ellison and Pargment, as reported by Simpson (2005), an increasing number of studies indicate that those who are more spiritual experience a greater sense of well-being and life satisfaction, cope better with stress, and are less likely to commit suicide.
Ryan (1995) theorized that individuals that lack spiritual beliefs are at risk to experience excruciating pain and feelings of rejection as they search for meaning in the world. Thus, it can be suggested that spirituality is a source of hope, meaning and purpose, particularly during difficult times. Research exploring the relationship between counselors’ sense of spirituality and the development of symptoms of secondary traumatic stress is limited. Pearlman and Saakvitne (1995) suggested that the development of vicarious traumatization may be linked to the counselor’s sense of spirituality. Through their research, they suggest that counselors with a “larger sense of meaning and connection” are less likely to experience symptoms of vicarious traumatization (p. 161).
While there is an existing body of literature available in the separate areas of spirituality in counseling practice and prevention of compassion fatigue among counseling professionals, there is virtually no literature, conceptually or empirically linking the two areas. External issues such as caseload limits and supervision have been investigated, yet the counselor’s internal coping mechanisms have been largely ignored. In an effort to examine the relationship between counselor’s level of spirituality and development of compassion fatigue symptoms, Simpson (2005) conducted a study composed of counselor’s from regional mental health centers, residential care facilities, private practitioners and schools throughout a southern state. Volunteers’ eligibility for participation in the study was dependent on current, active employment as a counseling professional. Additional demographic information was collected to allow comparison of the groups. Of the participants (n = 223 ), the majority of the respondents were female (n = 190), white (n = 167) and employed as school counselors (n= 144). Scores on the Spiritual Involvements and Beliefs Scale – Revised (SIBS-R) were utilized as the predictor variable. Scores for the respondent group (M= 131.35; SD = 15.70) were slightly higher than norms for the norm referenced group (M=113.1; SD=20.9) The Compassion Satisfaction/ Fatigue Self-Test for Helpers (CFST), a measure of compassion fatigue served as the criterion variable. Participants scores (M = 27.95; SD = 11.92) were comparable to the norm referenced scores (M = 28.78, SD = 13.4).
The variables of SIBS-R score and number of trauma victims on a counselor’s caseload were found to have a significant predictive relationship with the potential for development of compassion fatigue symptoms in this sample. Level of spirituality and the potential for the development of compassion fatigue correlated negatively implying an inverse relationship: as spirituality decreases the likelihood of compassion fatigue increases. The variables of age, race, gender, years of experience, and occupation had no significant predictive relationship with the potential for development of CF symptoms.
As there is no current consensus on a profile that suggests risk for symptom development, exploration of how counseling professionals cope with the stressors of working with traumatized clients has been largely limited to external behavioral responses such as supervision and caseload limits. Exploration of the internal coping mechanisms of counselors in response to working with trauma victims has been virtually overlooked in existing research. “A greater awareness now exists in education and health services that if a person’s spiritual needs fail to be addressed, a person’s emotional well-being is put at risk” (Morgan, 2004, p. 8).
The results of Simpson’s (2005) study suggest that counselors’ internal coping resources have the potential to play a significant role in protecting clinicians from debilitating secondary traumatic stress responses. It seems that one key to assisting counseling professionals in the avoidance of and coping with CF symptoms may be education on the concepts of secondary traumatic stress. Additionally, encouraging counselors to maintain acute self awareness of responses to trauma clients and educating practitioners on resources available to assist in the treatment of symptom development may minimize the proportion of clinicians experiencing CF symptoms. One speculation is that different coping skills may be needed to combat stressful situations than the skills used to prevent stressful situations. Thus, it is critical that counselor education programs expose students to these concepts during the training of counselors. Additionally, it is postulated that if it is true that counselor experience is inconsequential to the development of secondary distress symptoms in counselors, then educational programming and advanced training could be of vital importance to all counseling professionals at all levels of experience.
If counselors are taught to understand that CF symptoms sometimes result from counseling traumatized individuals, they will be more likely to prepare themselves for prevention of its symptoms. This may be particularly true for more seasoned counselors who may feel immune to the effects of secondary distress due to their experience level. If aware of the possible development of CF symptoms, therapists will not be easily overwhelmed or become shocked if symptoms development should occur.
Additionally, if counselors are able to assess the development of compassion fatigue, they will be more apt to seek assistance and collaborate with peers and supervisors when in distress. This research does support the existence of a relationship between a counselor’s level of spirituality and the potential for development of CF symptoms. It supports the need for an inclusion of a spirituality course in counseling curricula to help counseling students become aware of their own spiritual development and its effect on the counseling relationship.
Counselors who are unaware of the potential hazards of their work may simply leave the field due to its difficult nature and their difficulty coping. If aware of the challenging nature of the work and the resultant naturally occurring potential for CF, new therapists may be more willing to process upsetting material and seek assistance from others. In particular, counselors trained to pay attention to their own reactions to clients may be able to identify their own CF symptoms. Consequently, quality of care is enhanced and the traumatized client population is protected when mental health professionals obtain educational training in this area.
References
Athur, N.M. (1990). The assessment of burnout: A review of three inventories useful for research and counseling. Journal of Counseling and Development, 69, 186-189.
Chrestman, K.R. (1995). Secondary exposure to trauma and self reported distress among therapists. In B.H. Stamm (Ed.), Secondary traumatic stress: Self care issues for clinicians, researchers, and educators (pp. 29-36). Lutherville, MD: Sidran Press.
Cooper, A.E. (2003). An investigation of the relationships among spirituality, prayer, and meditation, and aspects of stress and coping. Dissertation Abstracts International (UMI no. 3084474).
Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Bristol, PA: Brunner/Mazel.
Graham, S., Furr, S., Flowers, C. & Burke, M.T. (2001). Religion and spirituality in coping with stress [Electronic version]. Counseling and Values, 46(1), 2-14.
Koenig, H.G. (1999). The healing power of faith. New York: Simon & Schuster.
Morgan, H. (2004, June). Spiritual healing. Learning Disability Practice, 7(5), 8-9.
McCann, I.L. & Pearlman, L.A. (1990b). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149.
McCann, I.L. & Saakvitne, K.W. (1995). Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In C.R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 150-177). New York: Brunner/Mazel.
Pearlman, L.A. & MacIan, P.S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 558-565.
Pearlman, L.A. & Saakvitne, K.W. (1995). Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In C.R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 150-177). New York: Brunner/Mazel.
Ryan, P.L. (1998). Spirituality among adult survivors of childhood violence: A literature Review [Electronic version]. Journal of Transpersonal Psychology, 30, 39-51.
Simpson, L. R. (2005). Level of Spirituality as a Predictor of the Occurrence of Compassion Fatigue among Counseling Professionals in Mississippi. University of Mississippi.
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Tuesday, July 16, 2013
Counseling is not for Sissys
Long hours, High drama, High hopes, Great rewards is how I would sum up my experience as a therapist in the Mental Health and Drug and Alcohol field. Mental Health is a challenge in of itself. Add addiction to the mix and we have an explosion or implosion ready to happen at any given moment. Work with an inpatient population and one immediately recognizes it is far more challenging than an outpatient or private practice setting.
A normal day can consist of a Paranoid Schizophrenic with a Crack addiction running after you with sheer panic upon their face, because there is a bee in the bathroom. It does not matter if the Borderline Heroin addict is laying on the floor screaming for comfort meds or the Treatment Team meeting one was suppose to be in attendance fifteen minutes ago with the boss texting, "where are you" is in progress. The bee has to be removed from the bathroom Right Now! This can be one's first two hours at their job place.
Inpatient means girls fighting over hair brushes, color pencils and telephone time. It can mean men fighting over the music station or the famous, "he looked at me with an attitude". Yeah, this stuff is better than any movie flick. The job is never boring, can crush your last remaining nerve, exhaust you and it all has to be done with an empathic compassionate approach, because we are the professionals and there is no time to be human. You leave "human" at the curb when you arrive for work and pick it up on the way to your car before you drive home for the night that is probably in ten or so hours. I wonder what a normal eight hour workday would look like? I will let you know when I have experienced it. I can tell you one thing we all have in common. That dreaded fear when it is ten minutes before you are ready to leave for the evening on a Friday, and one of your patients decides to leave AMA or needs to be stepped up. Monday morning when you cross your fingers and hope 20 new patients did not get admitted over the weekend when two counselors are out.
Lunch while in a meeting getting updates about patients, presenting new patients and discussing the events from the night before, which can range from the person out on the fire escape, to the person who cheeked their meds, to the person who had a seizure, to the person who would not get up for vital signs, to the person who snores too loud.
We hear all sorts of things in one on one sessions from the horrific to the bazar to the "are you kidding me" all with that professional straight face only a person in this field can manage.
Groups are fun. So are the family sessions. No. We cannot fix so and so. Yes. Family Counseling or a support group is encouraged, then there are the insurance companies.
Outpatient therapy means the person goes home. Inpatient therapy means you are met at the car, followed to the time clock, and all the way to the nurse's station, back to the chart room, and all the while you are being told how urgent it is to have laundry detergent.
It means you carry three heavy charts with your lunch bag, water bottle and oversized handbag across a parking lot to another building, climb three flights of stairs, manage to get the key out to unlock your office without dropping any of the above, walk into the office, place your lunch bag on the shelf where all your books sit, place the handbag in your desk draw, click on the computer, look for a spoon to eat your yogurt, while reading your email, assigning new patients to counselors, looking at your online calendar to see who needs an assessment, a treatment plan, a PCPC, discharge planning, a call to their probation/parole officer, who needs a court date continued, and discover you have no spoon to eat that yogurt, and debate whether you walk down three flights of stairs to get one, or settle with the plastic fork instead.
What an amazing field I am in and I would not change one single minute.
A normal day can consist of a Paranoid Schizophrenic with a Crack addiction running after you with sheer panic upon their face, because there is a bee in the bathroom. It does not matter if the Borderline Heroin addict is laying on the floor screaming for comfort meds or the Treatment Team meeting one was suppose to be in attendance fifteen minutes ago with the boss texting, "where are you" is in progress. The bee has to be removed from the bathroom Right Now! This can be one's first two hours at their job place.
Inpatient means girls fighting over hair brushes, color pencils and telephone time. It can mean men fighting over the music station or the famous, "he looked at me with an attitude". Yeah, this stuff is better than any movie flick. The job is never boring, can crush your last remaining nerve, exhaust you and it all has to be done with an empathic compassionate approach, because we are the professionals and there is no time to be human. You leave "human" at the curb when you arrive for work and pick it up on the way to your car before you drive home for the night that is probably in ten or so hours. I wonder what a normal eight hour workday would look like? I will let you know when I have experienced it. I can tell you one thing we all have in common. That dreaded fear when it is ten minutes before you are ready to leave for the evening on a Friday, and one of your patients decides to leave AMA or needs to be stepped up. Monday morning when you cross your fingers and hope 20 new patients did not get admitted over the weekend when two counselors are out.
Lunch while in a meeting getting updates about patients, presenting new patients and discussing the events from the night before, which can range from the person out on the fire escape, to the person who cheeked their meds, to the person who had a seizure, to the person who would not get up for vital signs, to the person who snores too loud.
We hear all sorts of things in one on one sessions from the horrific to the bazar to the "are you kidding me" all with that professional straight face only a person in this field can manage.
Groups are fun. So are the family sessions. No. We cannot fix so and so. Yes. Family Counseling or a support group is encouraged, then there are the insurance companies.
Outpatient therapy means the person goes home. Inpatient therapy means you are met at the car, followed to the time clock, and all the way to the nurse's station, back to the chart room, and all the while you are being told how urgent it is to have laundry detergent.
It means you carry three heavy charts with your lunch bag, water bottle and oversized handbag across a parking lot to another building, climb three flights of stairs, manage to get the key out to unlock your office without dropping any of the above, walk into the office, place your lunch bag on the shelf where all your books sit, place the handbag in your desk draw, click on the computer, look for a spoon to eat your yogurt, while reading your email, assigning new patients to counselors, looking at your online calendar to see who needs an assessment, a treatment plan, a PCPC, discharge planning, a call to their probation/parole officer, who needs a court date continued, and discover you have no spoon to eat that yogurt, and debate whether you walk down three flights of stairs to get one, or settle with the plastic fork instead.
What an amazing field I am in and I would not change one single minute.
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