Thursday, April 30, 2009

the investigation is over!

I wish I could do this to Mr. boss man at the shelter, unfortunatly, that would definitly get me in worse trouble then I was in.  Some of you may recall that I was being formally investigated for unprofessional conduct...two months ago.  Well, I finally got my sit down meeting with the executive director as well as my supervisor.  Joy. of. joys.  The only thing I was looking forward to about this was that once it was over, it would be OVER.  It was hard for them to find a time to meet with me as they didn't want to break out of their presious 8-4 days, but it eventually happened.  

So Mr. boss man sat down and told me how wrong I was, and how I'd been unprofessional.  He then gave me a chance to speak.  I did not deny the accusations.  I agree, that wasn't the best I've ever done, and there were certainly better ways to handle the situation.  I learned a lot from it.  What I asked, when he said I could speak to it, was what was happening to the clients after their brutal verbal abuse and discrimination of another client.  The answer, nothing.  And no matter how hard I tried to acknowledge that I wasn't disputing the fact that I was wrong, our ED refused to acknowledge that there was even the slightest possibility that the clients had done anything wrong.  Heck, I wasn't even saying that the clients had done something wrong to ME, which I still believe they did, but it was the things they said about another client that really, really got to me, which I tried to express.  However, I was not heard.  I mean, really, it makes sense, Mr. Boss Guy has no idea who I am, he didn't even know I had been a permanent employee of the shelter.  At one point, and i counted, he had introduced himself to me four times thinking I was a new staff person each time... and he has NO idea what goes one with the clients...because he's never there to talk to them, and NEVER there at night.  

But enough's enough.  By the time I left his office, I was tearing a bit.  I wanted to just run out, but my supervisor stopped me and pulled me into his office.  And I'm glad he did.  He told me that he knew that what happened wasn't representative of me, and he knows and respects the way I treat the clients and the respect I have for them.  After getting beat down so much at that place, it was nice to hear.  I still left and cried my way home though.  

It occured to me, as I got out of the car, that my neighbours, if they see me, must think I'm crazy for all the times I've come home crying.  Then it further occured to me, that with only one exception it's all been related to the job at the shelter... can you say "unhealthy work environment"?  (interestingly enough, the other time was related to volunteering at Street Ministry and an incident with one of my shelter clients).  I started to have a panic attack when I walked in the door, which totally surprised me, and, here's where I'm proud of myself, I said to myself "no, you're not having a panic attack, there are better ways to deal", and I took some deep breaths and chilled out and was fine.  YAY!  

Now for the funny story!  So, when I work at the shelter, I generally wear jeans, a hoody, and skate shoes with my hair in a pony tail.  Now that I'm working with the work placement team I have to look professional, so today I was wearing black pants, a button down shirt, a jacket, and heels, my hair was up nicely in a clip.  When I walked through the drop in to get to the office, the entire room went silent as my clients just staaaared at me walking through.  I HAVE to remember that if I know I'm going there after work to bring a hoody or something, at least, and some flat shoes.  

So that's my today.  I'm feeling okay now, and I'm glad it's all over.  I am still not impressed, but hey, philosophies and policies like that are why I got another job. I really miss the shelter clients, but I'll still see them sometimes, I'm not dropping off the face of the planet.  And as my supervisor said today, my professional career is on it's way!  Hopefully I can go to sleep early tonight, and when I wake up it will all just be a memory long forgotten...well, except for the letter on my file for the next two years (assuming of course I stay casual for that long).  

Tuesday, April 28, 2009

Fire Yoga

The next person who says to me "well, isn't yoga just like stretching or something" is going to get a smack (at least inside my head).  If yoga was "just like stretching or something" I wouldn't have such sore arm muscles right now that I could barely lift my arms above my head.  

Yoga last night was awesome.  It almost killed me, but it was awesome.  Our teacher focused on the element "fire" and well, considering it's hot yoga to begin with, well, lets just say I was HOT!  When the hot room feels cool at the end because you're not engaging your "inner fire" or whatever it was, well, that says something!  

So, the point is, there are many different styles of yoga, just like, well, the fact that there are many different styles of therapy!  Someone who goes to a therapist for a couple sessions of soluation focused therapy is going to have a very different understanding of therapy then the person who went to years of old school psychoanalysis or someone who went to a practioner who focuses more on the Gestalt model.  

I'm not sure there was a real, true, point to this post, other then that my arms are soooooo sore and I need to whine about it somewhere.  Bestest bud is out of town on vacation, and she's the one I normally whine to first... perhaps that says something about my life?  

Monday, April 27, 2009

What I'm reading this week: The culture of our disconent

Small, M (2006).  The culture of our discontent: Beyond the medical model of mental illness.  Washington, DC: Joseph Henry Press.

To start off with, let me say I really liked this book.  Meredith Small is an anthropologist who sets out to look at models of understanding mental illness in both Western Society and around them world.  I've never read much anthropology, so I'm not sure how things hold up from an anthropological stand point, but from a Social Work perspective the book was well written, concise and easy to understand.  To be honest, my favourite part about it was the length; not too long and not too short!

The stage is set in the introduction which describes the American Psychiatric Association's annual conference.  Small is surrounded by drug advertisements and drug representatives and says, "the ads addressed a cornucopia of negative human behaviors, and every symptom, syndrome or condition called for pharmaceutical treatment" (page 2).

The first chapter of the book looks at the impact of the medical model on mental illness, while the second chapter explores alternative models already present in Western Culture.  Third, Small looks at the biological basis for mental illness citing a variety of studies on monkeys (or non-human primates as the book describes them).  Moving on the book looks at how diet contributes to mental illness and how the slow change in diet of a country exposed to Western styles of eating can have mental illness increase in prevalence.

The middle of the book begins to look at things from the perspective of cultural anthropology.  Small discusses how mental illness is viewed in different cultures and the impact this has.  Next she discusses how some mental illnesses appear to be "culture bound" appearing only in certain populations living in more isolated parts of the world.  Small further discuss different treatments considered to be the norm in different parts of the world, placing importance on the link between the believed cause and the selected treatment (i.e. if possession causes mental illness then an exorcism is necessary).

The book ends without coming to a conclusion about which model is best, which is something I appreciated.  Small believes that what is universal, is that in all cultures treatment of mental illness is tied to hope.  "Sadness and despair might be the hallmarks of mental illness, but quite remarkably, every culture believes that something can always be done to bring relief" (page 4).

All in all, the book was a good read.  I learned a surprising amount from it without feeling that I was being overwhelmed by difficult to understand information.  The content flows together nicely with good transitions from one chapter to the next.  While I would recommend this book to anyone interested in learning more about Western thinking, I would especially recommend it to professionals who deal with a diverse population on a regular basis or with recent immigrants.  I would not however recommend this book to people who are looking for books about a very "anti" medical model of mental illness.  The book presents each view equally and it in no way raises one model above any other.

Sunday, April 26, 2009

this is not a post about Yoga Therapy

This is not a post about yoga therapy, although I've seen quite a few of those in my rss feed lately.  This is a post about why I think yoga can be good therapy, an adjunct to therapy, or simply an alternative to therapy.  Now, as a social worker I'm biased, and after class yesterday I made my facebook status "Still Dreaming thinks that sometimes yoga is better than therapy" (note the sometimes).  I firmly believe in the importance of talking things out.  Of course, I'm also a big talker, so it makes sense.  

I went to yoga Saturday for the first time in a month (I've been too sick) and while I was thinking of nothing but my breath, I had quite a few thoughts and made some interesting connections.  

For starters, at Yoga, the teacher always says that they are "guiding us through the practice".  I love that line, they're not teaching, they're guiding, we're the ones doing the work.  That's how I've thought of therapy both as client, and counselor.  The therapist is the guide.  They help the client do the hard work.  

Yoga is about where you are at in the moment.  It's not about the future, it's not about the past.  It's about accepting where you're at that day and that time.  It's about pushing yourself, yes, but it's also about listening and connecting with your body and only doing as much as you are able on any given day.  This is an important life lesson, one that can certainly be learned through therapy as well.  

Yoga is about centering yourself and finding those connections.  Therapy too can teach centering, connection, calmness etc.  In yoga we breath deeply and together, it's like the relaxation exercises learned in therapy, combined with the cardio that's recommended to destress and boost seratonin.  

Finally, practice improves things, and creates body memory.  Moksha Yoga, the kind of yoga I go to right now, is a set series of asanas, so things are almost always in the same order.  Even though I hadn't been in a month, my body knew.  It knew what was next, it knew where my hands went, it knew what to do.  The same thing can be true with the skills a person learns in therapy.  You practice and practice, you might not use them for a while, but then when you need them, they're still there.  I'm a little sore today, after yesterday's class, and the same way, it might be a bit hard when you have to pull them out again, but it is so, so worth it.  

Thursday, April 23, 2009

CBT

Something I've been thinking about a lot lately is Cognitive Behavioural Therapy.  When I first read about it, it confused me more then anything else.  I remember looking at my professor and saying "I just don't get it", I also remember her smiling, and giving me a look that said she completely understood why I was having trouble with it, but was going to let me figure it out and not tell me.  I then chose to write a paper about it, applying it to a situation, so that I could gain a better understanding of it.

For a while, I thought I really had it.  I'm quite good at using it in my own life in fact.  Stuff going wrong in my life.  Okay, what was that activating event, what was that thing that started it off.  Okay, got that down.  Okay, what was my belief, what do I believe about this situation, perhaps I have a black and white principle that I'm using to cover this and forgetting about shades of grey, or maybe my belief is just plain negative, or wrong.  And of course what was the consequence, what happened when I followed my usual belief pattern.  Sometimes realizing this is enough to say "oh, okay, I don't need to freak out".  Other times it's really important to put the next step into place, to dispute that belief and put a new one in it's place.  Sometimes it's one we already know and can slide into comfortably, other times it's one that takes a little more work. 

Take this example with bestest bud, in this example, she does nothing wrong, and I let my beliefs and emotional consequences get me irritable.  Bestest bud and I are carpooling to choir practice.  The last time we carpooled to choir practice, we were late because of traffic.  This practice is around the same time of day, and bestest bud is meeting me at my house.  Bestest bud calls to check what time practice is and states that she's going to be later then planned as she is dropping off a friend on her way.  Getting grumpy, I immediately assume we're going to be late and tell her we mind as well just phone in late now because we'll never make it.  I decide to go sit in my car and sulk so that we can be on our way as soon as she gets to my place.  I am grumpy, bestest bud is tired and hungry.  Not a good combination.  This makes me not as pleasant a driver as I try to "zoom" around traffic to get on my way.  Turns out, we're not late.  In fact, though we're just on time, we're almost the first people there.  Oops. 

So, looking at this situation later, it was easy for me to see what beliefs I had and how they led to my irritability.  First of all, I believed that since we got stuck in traffic once we were always going to get stuck in traffic, even though it was a different season, as in, not winter!  Then I believed that if we were late it was the "end of the world".  Finally, I believed that bestest bud was going to make us late, even though she assured me it would work out, which it did. So, if I'd inserted some new thoughts the situation might have been different.  "Well, this gives me some extra time to play with the Sophie Cat" or "Bestest bud will probably be tired after school all day, I could make her a snack", or "well, if we're late, we're late, it'll only be a couple minutes, at least we're going to be there!"  So like I said, I can do it for myself.

Then though, there are clients.  I am constantly catching clients in these black and white thinking traps which are probably even more obvious to me since I just reread the chapter in my favourite text book a couple weeks ago.  The hard thing I find, is challenging them.  I'm also learning that sometimes we just have to let them go.  It's important to focus on the therapeutic goals and not insert our own goals.  Just because a client says five different things I think this ABC method could apply to, doesn't mean any of them need to be the focus of or session. 

I think one of the reasons I've struggled with understanding CBT is because I tend to think of it as something I could just "throw in" in an eclectic method, and maybe when I have more experience and practice I could, but right now, it's hard for me to do that.  If I was going to use CBT with a client, I think I would spend a session on it, and begin by explaining the ABC concept and then brainstorming places they could use it and finally getting them to practice at home, perhaps with some worksheets.  I think it's a great therapy, especially for people who struggle with very negative black and white thinking, but I don't think it always works, and there's definitely a time and a place for it.

Wednesday, April 22, 2009

What brings you here today?

One of the questions I like to ask when I'm doing an intake, an assessment, or now, a first counseling session, is "what brings you here today, what was different about today that made you decide to come in".  What I'm trying to
get at is the motivation for change, was it a sudden revelation or was it a long time coming?  Sure, you may have been thinking about seeing a counselor
for a long time, but what changed that you picked up the phone today, because something did.

What I've discovered, is that people seem to have a really hard time answering that question.  When I was doing detox intakes it was often "well, I'm drinking too much" or "my worker made me".  Well, those are decent reason, but what prompted you to walk in our door, what was that mental process, it's not an easy thing to do after all.  Perhaps you said to yourself, "enough is enough, I'm ready for this" or something similar.

Now, I'm getting transfer clients to build my caseload.  Basically, not everyone in the program is required to attend counseling, but they are able to access it when they need it.  Often they spend more time working with the job people and the employment support people.  So, I'm getting clients who are partway through the program but are looking for counseling now.  This is good.  BUT they seem to also have a very hard time.  What brings you here today.  The answer I usually get, is "life issues".  Well yes, but you've been thinking about this particular thing for a while, what was the thing that pushed you to make that call?

Thinking from the clients perspective though, it's a hard question.  What was that thing that made you do it.  I know when I first chose to get counseling, I found it really hard.  Making that call was agonizing.  I purposely planned it so that I would be leaving a voicemail rather then having to talk to a live person.  I stood there in the kitchen with the cordless phone in my hand deciding whether to dial.  But, I had a good reason for why that day out of other days, it came the day after I felt I had been intensely betrayed by two people I trusted a great deal.  That was what pushed me over the edge.

Change is a hard process and I really believe that it's important to be aware of our motivations for change.  Why are we doing what we do.  It's a lot easier to stick to your plan if you understand the reason things came about in the first place.  Further, it helps us understand ourselves better when we're aware of our motivations and the reasons we do things, even if it's things we learn in retrospect.

Tuesday, April 21, 2009

I lol'd...documentation bloopers

So I have no idea if any of these are real are not, but I saw these posted on a social work community website and laughed my head off.  And since I'm sure we could all use a laugh...

Documentation Bloopers:

The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.

The client was in his usual state of good health until his airplane ran out of gas and crashed.

The client is a well-developed male lying on the sofa with his family in no distress.

Because she can't get pregnant with her husband, I thought you'd like to work her up.

Discharge status: alive, but without permission.

Patient was alert and unresponsive.

She is numb from her toes down.

The client had waffles for breakfast and anorexia for lunch.

She stated that she had been constipated for most of her life until 1999, when she got a divorce.

She slipped on the ice and apparently her legs went in separate directions in early December.

The client has been depressed ever since she began seeing me in 1998.

Healthy-appearing, decrepit 69 year old male.

Coming from Detroit, this man has no children.
 

Monday, April 20, 2009

gotta love it when they're out before they're in

So I had my first counseling session with a client today.  I felt like we moved waaaaaaaaaay too fast, but this guy was just eager to get things rolling and underway.  The thing of it was, he really wanted legal advice more then counseling, and so he wasn't really in the mood to slow things down.  

I have another client tomorrow who might come in.  She was kind of non-committal.  She's one of those clients who has seen just about everyone on our team and had some sort of falling out or failing with just about everyone.  Being the new girl, it's now my turn.  My supervisor thinks she's like me.  Who knows.  

Speaking of which, I had supervision today, which was nice.  I really like my supervisor.  I'm still kind of intimidated by her, but I think that's normal.  She seems to really care about the clients and about the staff, which is sooooooooo nice.  She said she was surprised I hadn't come and asked her more questions, but I really didn't have any for her.  I've sorted things out, and the other staff have been SO good about telling me stuff and helping me figure things out!  

My sinuses are still sore.  My ears were a bit better today though, instead it's my frontal sinuses giving me problems.  I've done the neti pot thing twice now.  It's a bit weird, but we'll see if it helps!  

Sunday, April 19, 2009

antibiotics and yuck

I don't like antibiotics.  I think they're a wonderful invention, I totally agree that their lifesaving.  I also think they're over prescribed, and generally, they don't make me the world's healthiest person (I tend to get stomach side effects of varying forms and severity).  That all said, I've now been on antibiotics for 17 days straight, and I'M STILL NOT BETTER!  

You've probably noticed that I've got down on my blogging, and it's because I've just been too sick.  What I initially thought was going to be strep throat again turned out to be a sinus infection...or shall I say, assumed sinus infection, because the doctors haven't x-rayed my head to look for it, just treated me based on my symptoms.  Which is fine and dandy considering I've had them before.  BUT, I should be better.  I'm on my second round of antibiotics, and I really don't feel much better.  Yes, the fever's gone, but seriously, my ears hurt SO much.  After some research, I've discovered that it's the tubes in my ears, reacting to the pressure in my sinuses.  Basically, it's like I'm on an airplane which is taking off and taking off and taking off with no escape.  I catch myself sitting at my desk and pulling at my ears like a little kid with an earache.  Bah. Humbug. 

Not all is bad though.  My new job is going well.  I'm still kind of bored, but more stuff will come.  I'm co-facilitating two groups/classes next week, and I did my first solo intake on Friday.  I have supervision Monday (yes, that's right, we actually meet with our supervisor on a regular basis, as a requirement).  And, I get to take a workshop in June which work is paying for!!  It's going to be SO much easier to get my continuing ed hours when work actually lets me take work time for it!  Besides all that, my coworkers like Sushi, which just makes the whole world better for me!  


EDIT:  So, I tried the neti pot.  Interesting, interesting, interesting.  I'm not sure I did it for long enough on each side, but I'm going to try again tomorrow.  Anything to get rid of the ear aches, and I'm all about the more natural and tried and true ways (as in, neti pots were used for hundreds of years before the invention of antibiotics). 

Thursday, April 16, 2009

Monday, April 13, 2009

My new job

So, I've written tons and tons about the shelter over time, but I haven't yet written anything about my new job in terms of what I do, and what our program does.  The simple answer is that we provide job search support and employment support to people with mental illness who are unemployed or underemployed and whose mental illness is stable and does not currently prevent them from attaining and maintaining employment.  Okay, maybe that's not a "simple" answer, but it's an answer!  

Basically, here's how it works.  It's a small program with yearly renewable funding (meaning my job is only a for sure till March 31, 2010 last year the funding got doubled though, so I'm not tooooo worried).  People get referred by a variety of providers or self refer.  We do an intake, talk about them at the staff meeting, and then hopefully, they get into the program.  

First thing on the agenda is a four week class.  It meets for three hours a day and usually has 4-6 people in it.  They cover topics like stress management, social skills, assertiveness, conflict resolution, job interviews, resumes, cover letters, employement expectations, working with mental illness etc...  The classes are run much more like a counseling group then they are like a lecture, or at least the social worky classes are, I don't do employment classes so I'm really not sure about them.  During the four week class they check in with a counselor (me) or an employment support counselor once a week for ongoing stuff/issues with the class.  

After class, they get a "report" card and have a review meeting.  Most people "graduate" and get their certificate.  Then they move on to the job development phase.  In this phase our job developers work with them on finding the job (or the right training) that works for them.  It's really personalized attention, and can be really helpful.  The job developers also have ins with a lot of employers who are willing to hire our clients.  

Also following class, clients are given the option of working with a mental health counselor to talk about ongoing mental health issues, family issues, whatever.  There are two of us (like I said, small program) and we sort of split this up.  

Once a client has employment (and our current success rate is over 75%) they are hooked up with one of our employment support counselors.  This person connects with them weekly (at first) and the goal is to provide people with longer term support so they don't crash and burn in their new job.  

Finally, there is discharge.  We usually work with people for about a year, but of course there is variation.  If a person is in our program longer then a year with have to justify it to our funders, but it's usually not too hard.  

And so, that's my program in a nutshell!

Saturday, April 11, 2009

My Office

As promised, here are the pictures of my office, complete with my favourite Sophie Cat picture.  You'll also notice her as my desktop background... if nothing else she's a coworker conversation starter "is that your cat?", "yes, her name is Sophie Cat".  







Wednesday, April 8, 2009

tired but good

This is Sophie cat when I thought she was sick, wrapped up and getting eaten by my giant Tigger (thanks to bestest bud).  She's all back to her normal self now despite conning hummus, cool whip, and assorted other foods out of me the past couple days.  

My new job is going really well.  I'll post pictures of my office soon (I'm waaay too excited about having my own office, and I also realized it won't happen in many of my future jobs, and I do believe in open office concepts, it's just FUN!  I'm slightly worried the job will be too boring, and while it's good, I'm definitely not used to people actually caring about what I do and how I'm doing.  Things are going to take a little getting used to.  No more having down days where I get to read fiction all night!  The sleep thing is difficulty, especially the waking up part, but I'll survive, I always do! 

Thanks for all the supportive comments on the last post.  You guys are awesome! 

Saturday, April 4, 2009

update on me

I've been off most of this week in between my two jobs, so naturally, I didn't bother to use any of my free time to write.  So, I'll try and make up for that with an update about how things are going. 

1. The Sophie cat seems just fine.  I have come to realize that I've never spent any time with her during the day (I've worked nights the whole time I've had her) and it's just how she is.  Plus, that day the caretaker was in to test my smoke detector while I was out and that probably scared her. 

2. Investigation at work.  This probably deserves it's own post, but in short, it's over.  I get to come in for a meeting to recieve my official letter of instruction...apparently it's not disciplinary though?  Anyway, I'm just a little mad, but at least it'll be over and done with (and I have A LOT to say about the difference between empowerment and clients having too much power). 

3. New job.  I went and had lunch with my new team this week.  They seem really nice, and I went to school with one of them, so at least I know her.  It was a welcome change to have them say how much I would like working there and that it was a good workplace as opposed to when I had my orientation at the shelter and was warned about particular staff members and particular shifts first thing. 

4. My emotional health.  I feel SO much better this week.  Definitely was good to have some time off.  I also spent time with friends and went out for coffee with someone I really respect.  She suggested going for spiritual direction, and I think I will.  I'm looking into it.  

5. My physical health.  If you look back at my blog, all year I've gotten sick every three months.  This pattern actually continues from before the start of the blog, it's just me.  The pattern failed, and only one month after the last occurance of strep throat, I am sick again.  After three days of having a low grade fever I finally dragged myself into Urgent Care last night and discovered that I have the dreaded "sinus infection"... ick.  Much as I don't want surgery, it'd be nice if I could just drill some holes in there so I could drain them and not waste 10 more days of my life on antibiotics.  SUPERGERMS!!!!!!!!!!!!!!!! (ahh run for your life). 

And so, that's me in a nutshell.  My new job starts Monday.  I now own a professional wardrobe, including high heeled shoes (if you can call an inch high, the point is, I have heels).  I'll post pictures of my cast once I break an ankle (shouldn't be long).  I also own makeup.  Now I just have to put in on... I was going to practice this week, but well, it never happened, so we'll just hope for the best Monday morning and I'll wind up at work looking like a drunk clown.  But I'm not sarcastic at all!

Happy Saturday!!!