Celina

I am posting this with permission from my client. My program, N*COMMON, is being featured in our company newsletter this month. As a part of our article, we're featuring Celina's success story. She was one of my very first clients; we worked together for over two years. This is a picture of her in our therapy room. She wore a leather jacket and lipstick just for the occasion. Here's the excerpt from the newsletter. (It's meant to sell the program so forgive the slightly cheesy tone.)

"Through her interaction with N*COMMON, Celina has steadily healed and found new hope in her life. Her husband left El Salvador and came to the United States to support the family, including their four children. When he stopped sending money, Celina was desperate to care for her family. She left El Salvador, where she grew up, and moved without her children to the U.S. to try to find work herself. She moved back in with her husband even though he'd been abusive from early on in their marriage. He continued the abuse, to the point that she feared for her life, and she found the courage to leave him.

"Feeling very alone and having become depressed, Celina started treatment with N*COMMON. Work with her therapist (that's me! :) ) began with helping her become stable, both emotionally and in her daily life. Emotional support helped lift her from the worst of her depression. She and her therapist focused on helping her cope with her feelings and manage the stress in her life. They then moved to processing the pain and grief she endured with her husband and in separating from her children. Celina began to understand her feelings and to work through them. As she discussed domestic violence in depth with her counselor, Celina stopped blaming herself and gained confidence. She began to leave the house more often and to engage in positive activities like English classes and exercise. Assertiveness and communication skills helped Celina manage the daily stressors of work and relationships. Now, Celina says, life’s ups and downs affect her less. When she meets a challenge, she problem-solves and bounces back quickly. She finds hope in her life, in telling her story and in sharing with others – Celina is now an inspiration to many!"

Hehe! She totally is. She was really excited to share her story.

Psychiatrists

Whew. Where do I start on this one. My thesis: (many) psychiatrists are (medically speaking) Loony.

My interactions with psychiatrists have been...unexpected. As far as I know, they are held to the standard of being the experts in my field. They are highest on the hierarchy of authority. The more serious or complicated a client is, the more likely the first line of defense will be Send Her to a Psychiatrist. Therapists look to them for the most accurate diagnosis and treatment recommendations.

Thus, I always expect a psychiatrist to say something like: "Here's her history, and her symptom profile, so here's my diagnosis and what I recommend." Ha! Wouldn't that be great. So far, it hasn't gone that way.

They always have their own ideas:

"Eh, she's just a little histrionic and needs someone to talk to."

Doc: "You know, it's okay to be gay." My client: "I know, but I'm not gay." Doc: "No but really, it's okay to be gay." My client: "I know, but I'm not gay. I'm here because I can't sleep."

They are often lacking in the gender and sexuality department.

"Your (gay, male, Hispanic) client reminds me of this Korean girl I used to see. She lived with this guy for a while who put her through school in exchange for sex. In the end, it really wasn't that bad of a setup." <--phjiodaweamkdopugwWTF??

Doc: "Did you know this drug helps with PMS?"

Client: "Yes. You've told me this many times."

2 months later
Doc: "Hey, did you know this drug helps with PMS?"
Client: "And no, I didn't have PMS in the first place."

With my clients, no matter what the problem: PTSD, anxiety, depression, impulsiveness, insomnia, being a human being--80% of the time they are prescribed celexa and trazodone. You don't like it? Meh, give it four weeks. You still hate it? Meh, give it four more weeks.

I'm sure there are perfectly logical reasons behind why they do these things. But all too often, my clients end up dropping out of treatment and deciding quite reasonably that their psychiatrists are the "los locos."

The Making of a Therapist

I am slowly preparing to leave my job, and I've begun telling a few of my longer-term clients that I'll be leaving in June. In preparation for my departure, I've decided to start a new series about my first years as a therapist. My heart is brimming with things I've learned, special moments with clients, questions and musings.

I told one of my longest-running clients yesterday. She's been coming for over a year and a half. She came in because of marital problems: her husband was psychologically abusive, mean, ornery, and generally a brute. She worked herself to the bone cleaning houses because he wouldn't help with any of their household costs. She was miserable. We tried a million things with her husband, to no avail, so we focused on helping her emotionally cope. A survivor of loss and abuse, she felt what helped her most was learning to maintain her emotional independence--not to let him "dominate my mind," not to react. We had all but given up on him, and we were working on helping her leave. As an undocumented immigrant, that turned out to be way more difficult than we anticipated.

Then, almost overnight, he changed. He was diagnosed with diabetes, and started turning his life around. He began helping with costs, childcare, and household tasks. He stopped yelling. His mood improved. He even went to work with her to help her clean houses. He started bringing the family to church. We were both shocked. "I ask him, 'Where did this new husband come from? Has he been hiding in the basement?'" She says. He blew our expectations wide open.

When I told her I was leaving, she teared up. "You have no idea how much you helped me," she said. "You really listened to me. I mean, I know that's your job, but I could feel that you really listened as a person, as a human being. No one ever does that. Family doesn't do that. Everyone always has their opinions and judgments. I can't tell you how much you helped me."

I was fighting back tears myself. Once in a while, life drops me into a moment like that--real. Frozen in time.

I think that's the #1 thing I've learned: that I should never underestimate the power of pure, unadulturated, supportive listening. When asked what they're looking for, and what has helped the most, that's what most clients say.

How to Appear Racist 101

A Korean-American client reports that she suffers from aches and pains and occasional insomnia. She doesn't describe any other symptoms or disclose information about her personal life or family. She says she has come in to see the social worker only because her doctor told her to. What should the social worker do?

A. Refer the client to a pastor at a local Korean church.
B. Refer the client to a neuropsychologist for testing.
C. Focus on the specific problem brought in by the client and help her develop her own goals for therapy.
D. Ask the client if she has been feeling depressed.

Dear social worker: limit your scope of practice and inflate your ability to generalize by choosing one. What would you choose? Cause did you know the answer is "A"? Forgive my language, but WTF?

A friend and I are studying for the social work licensing exam, and we send each other ridiculous questions we come across in the practice exams.

At the beginning of therapy with a Caucasian social worker, an African-American client is MOST likely to experience which of the following?

A) High self-expression.
B) Significant anxiety.
C) Transference.
D) Lack of motivation.

We're actually supposed to answer this question. My answer: Dear Social Work Licensing Board: Let's critically examine the presentation of this question. And the answer is "C." What kind of transference, you ask? Transferring of what exactly? Excellent question. The rationale makes sense to me: "It is recommended that therapists consider the influence of historical hostility as a necessary part of effective therapy with African-Americans." That's very helpful. Thanks. Apparently we missed the importance of EFFECTIVE WORDING in helping us appear less racist!

Lyrics of life

I won't reveal this band because it may cause judgments. But I was drawn to them powerfully because of their beautiful, beautiful lyrics. They exemplify so much of life to me. :)

A personal philosophy that resonates with me:

Feed my will to feel this moment urging me to cross the line.
Reaching out to embrace the random.
I embrace my desire to feel the rhythm, to feel connected...
to swing on the spiral of our divinity and still be a human.
Reaching out to embrace whatever may come.
I'm reaching for the random or what ever will bewilder me. Whatever will bewilder me.

On love, continual rebirth:

My blood before me begs me open up my heart again.
And I feel this coming over like a storm again. Considerately.
As the walls come down and as I look in your eyes,
my fear begins to fade, recalling all of the times
I have died and will die. It's all right. I don't mind.

On communication, and also reminds me of politics:

I know the pieces fit cause I watched them fall away
Mildewed and smoldering. Fundamental differing.
We cannot see to reach an end, crippling our communication.
I know the pieces fit cause I watched them tumble down.
No fault, none to blame. It doesn't mean I don't desire
to point the finger, blame the other, watch the temple topple over.
To bring the pieces back together, rediscover communication.

The poetry that comes from the squaring off between.
And the circling is worth it.
Finding beauty in the dissonance.

"That really just happened!"

--Me

It was almost four years to the day of our first date. We were in Siler City, NC, where we first met. For the first year of our relationship, we worked at a community health center there.

Four years, two countries and three states later, Jason is in med school, and he was working at the clinic for one of his med school rotations. I went with him on his last day to visit our old friends. After the day ended, we went for a walk in a park nearby, where we used to go for walks when we worked together. We'd spend our lunch hours there walking, holding hands, and talking...it was a special place for us.

We walked along a little trail for a while. As we neared the end, we stopped on a bridge overlooking a stream. Jason turned around and faced me. He took a breath and said, "I love you." I said, "I love you too..." and he got down on one knee, pulled out a BEAUTIFUL ring, and asked me to marry him. I was so busy crying I forgot I was supposed to say something! I was totally surprised and absolutely over the moon.

Thank you for opening a window;

the sky is clear as my mind is now.

It's well worth the time that it's taken

to get here now.

Yeah, it's well worth the time that it's taken

to get here now.

The lines have all been drawn.

I know where I belong.

--Greg Laswell

EMDR

"Both the left and right hemisphere may be conscious simultaneously in different, even mutually conflicting, mental experiences that run along in parallel." --Neuroscientist William Wolcott Sperry

I tried a kind of therapy called Eye-Movement Desensitization and Reprocessing (EMDR) today.

EMDR tries to address whatever we get "stuck" on inside--those things we can't stop ruminating about, or memories that haunt us, or emotional blockages--through the body as well as the mind. As the theory goes, entering those difficult feelings/images while juxtaposing physical stimulation can help to dislodge them, so they can be reprocessed.

I was pretty skeptical. The jury is still out in the mental health world about EMDR. But I was back in my desperation stage of insomnia, and I'm lucky enough to have a therapist who's trained in EMDR. She wasn't sure it would work for me, either.

It was not what I expected. I got surprisingly emotional. (Course I tend to do that on three hours of sleep--but maybe that made me especially open to EMDR.) I could feel that it unleashed feelings for me in a visceral way. It was like it got to things in my gut that I don't reach through my thoughts. It was altogether cathartic and uncomfortable and involuntary.

I saw more clearly that all the parts of my self are equally real: the part of me that has it together, and the part of me that does not. I tapped into a vat of emotion that runs alongside me as I go through my daily life attending to other things. I may at once think myself out of something and be subject to it.