Things I've Learned

Today I got the clients to do an exercise for the last day of group in which they had to think of ten things they'd learned. Either things about employment, or coping skills, or job searching, or themselves, and so I figured that while they were working on it, I'd try and come up with ten things I'd learned in the past four weeks as well. I came up with 14 and thought I'd share them.

1. I am an adult... for real (I think I learn this one at least once a month though)

2. B12 shots rock my world

3. I don't want fixing, I want support (again, I learn this one a lot)

4. Half moon pose needs to be done from my finger tips

5. How to do a proper headstand the "yoga way"

6. How to stake peas and beans

7. It might not happen even when it feels right

8. Don't drink drinks made by a certain friend

9. How to be a better "mark" in ultimate frisbee

10. Gluten free buns are kind of gross (but they're buns I can eat so I eat them anyway)

11. Your SIN card no longer counts as ID for criminal record checks

12. Republic of Doyle is a great Canadian show

13. Cats at the office are good, transporting said cats to/from the office is not

14. Sophie Cat is a good judge of character (or at least dislikes the same people I do).

chronic suicide ideation

As most of you know, I work in a program for adults with mental illness who want to reenter the workforce. One of the main criteria for program admission is current stability. In other words, you have to be emotionally ready to work and have enough control over your symptoms to function in a work environment. We'll support you, we'll advocate for you, we'll work with your employer, we'll help you, etc, but we aren't a placement agency, we help people find jobs in main stream employment. Of course, because no one is perfect and mental illness can be unpredictable, not all over our clients are able to find employment, and they don't all remain stable. Right now, I'm working with a client who is very not stable, and it's a little bit outside my comfort zone.

Said client is chronically suicidal. Suicide ideation is part of her daily life. However, since entering our program she has attempted suicide on three different occasions. She was not stable enough to maintain employment. So, it came time to discharge her and refer her to more appropriate services. So I did... refer her that is. She and her doctor decided that a hospital day program was a good option for her, it offers DBT and CBT skills training and would provide her with tools and a lot more support then our program can. So the client and I agreed that I would discharge her as soon as she started the program...

The program kept bumping her date of admission back, and so, two and a half months later, here we are. We meet for counselling, but I feel like we're getting no where. Every session is potentially our second last session (we'll do a last one for closing once she starts) and because her suicide ideation is so prevalent it's almost all we talk about. We have safety planned so many times that both of us could probably recite the whole thing backwards, forwards and upside down. The crisis lines have heard from her day in and day out for months. The mobile team won't see her right now because it's a "long standing issue". I was out of ideas.

So, when I saw her for the second time this week, an extra session, just to get her through till her day program starts Monday (we hope, we hope, we hope) I took a totally different approach. Rather then doing the whole ASIST thing where you explore reasons for death, reasons for life, align yourself with the side that wants to live, safety plan and contract (which I don't do anyway), I thought, we'll, this isn't changing anything, screw this. So, we talked about death. We talked about who finds her body, we talked about how long it stays in her apartment, we talked about who feeds her gerbil, we talked about her funeral, her ashes, the affect on different people in her life, and you know what, our session went a whole lot better. I wasn't frustrated (something my student noticed in our last session) and I left more room for silence and thinking. She wasn't forced to answer the same questions (with the same answer "I don't know") as usual. It certainly wasn't the answer, and it certainly didn't fix her suicide ideation, but it seemed to be a better approach.

In April I'm going to a two day workshop about working with chronic suicide ideation and it's connection to trauma. I'm super excited. I felt very unequipped in this situation, and while I did make all sorts of appropriate community referrals, the person she felt comfortable talking to was me. So I did research, I consulted coworkers and my supervisor and I kept in mind that not only do I not know everything, but I don't have to know everything.

Workshop

I don't know if I've ever mentioned on here just how hard it is for me to sit still. I'm pretty sure I have, but in any case, I'll say it again... I CAN'T SIT STILL! I mean, I do fine in counselling session, but I limit those to an hour, and when I lead groups I'm up at the whiteboard a lot. I can fidgit all I want when I'm just doing paperwork and no one cares if I walk up and down the hall or take a trip to the photocopy room. Why does this matter? Well, today I have to sit kind of still...

Today I am going to the first of four workshops about how not to screw up my social work student. This is a good thing. I really don't want to screw her up! BUT, I also can't say I'm all that excited about having to go to school all day. Especially because it's at the other university in town, not the one I went to. So it's unfamiliar, I don't know the presenters etc... My hope is that someone from my school will be taking it. See all first year practicum supervisors from that university have to take it, so there should be someone from my class there, you would think. I'm sure it will be fine.

During the workshop today we get all sorts of information about how to get things set up, their learning contracts and deadlines and stuff. We also have to do things about our supervision styles, learning styles and stuff like that. That's the part I'm not excited about. Although I'm an extrovert, I'm not a huge fan of meeting large groups of new people and having small group discussions with them. Oh well.

In anycase, I gotta get out of here. It's wonderful to be able to sleep in, but I suppose I do have to leave eventually. I was planning to take the bus, so I wouldn't have to park, but I finally decided I'm just going to drive afterall. It's funny, becaues last year at this time I didn't have a car yet and I took the bus EVERYWHERE or rode my bike, and now I'm so used to the car.

and, in other news, the cats are fighting...must.go.end.cat fight.

Hearing Voices - Workshop

Last week I went to a fascinating workshop called "Hearing Voices that are Distressing". It's based on the idea that a person can experience hearing voices, as someone with schizophrenia might, the same way a person can experience a physical disability by being in a wheelchair for a day.

The first part of the workshop was general discussion/information about schizophrenia/psychosis and the organization which held the workshop. Next though, was the really interesting part.

Each person put on a pair of headphones and pressed play on a tape. The tape mimiced the voices that the workshop creator has experienced in her life. Then we were put through a mock psych assessment at a contrived psychiatric hospital. We had to do a mini mental status exam, a cognitive assessment and a reading comprehension test. The "staff" (workshop leadership) behaved in a very cold and clinical (old school clinical) way. We also had to go on a "errand" out in the community and write down some information, all while wearing the headphones and hearing the voices. I was definitely a one of a kind experience.

I found that all I wanted to do was sit down and listen to the voices. I didn't want to do any of the other stuff at all, for me, it really opened my eyes to why someone hearing voices might isolate themselves. Other people found themselves listening to the directions of the voices (stop it, put your hands down etc...) while others found themselves very frightened and frustrated. And we all knew that the voices were a tape!

Afterwards there was a debrief time, and even though I'm normally a very talkative person all I wanted to do was go home and rest. I felt soooooo over stimulated. Of course I had to work though, and go to a goodbye party...

Overall, it was a great workshop, and if you ever have the chance to do something similar I would highly recommend it!

Social Worker...

Here we have a picture of me giving Oliver Lockhart a bath. He looks sort of like I've been feeling.

I finally feel like a social worker, for all the wrong reasons. I feel like a social worker because my case load suddenly doubled because the other counsellor is leaving. I feel like a social worker because our 8 person team only has 6 people, one of whom just got fired. I feel like a social worker because I have tension in my back. I feel like a social worker because I sometimes take at least a full day to respond to my clients phone calls, and I'm often a day behind on my documentation.

Fortuntately, the good stuff keeps me going.

I feel like a social worker because I can see that there are clients whose lives I am making a difference in. I feel like a social worker because people respect my opinion, even though I rarely give it. I feel like a social worker because I can write letters of support for people to other professionals and believe that they'll mean something. I feel like a social worker because I finally have work to do all day instead of reading "Stuff Christians Like" all morning. I feel like a social worker because I'm finally starting to understand the ins and outs of the multiple systems that make up "the system" even though I thought I knew them before. I feel like a social worker because I KNOW that I'll never learn it all.

Tomorrow I'm headed to a workshop for the morning, then a goodbye lunch for the other counsellor, and then we'll see. I have a counselling session booked and I have to fix a letter I'm writing for my supervisor/team.

My spiritual director taught me a very neat prayer that dates back over 1000 years. It is a simple reflection on that which you are most grateful for and that which you are least grateful for. Today it is as follows:

I am most grateful for an evening spent with the cats, tea and a mystery novel (as well as a couple episodes of The Simpsons). I am least grateful for the stress at work which causes me tension and for the stomach ache I've had on and off today.

Workshop Tomorrow: Mental Health First Aid

So tomorrow and Thursday I am taking a Mental Health First Aid workshop.  At first I wasn't all the interested in it, but it's got a really great reputation and I'm really looking forward to it.  

Basically, the idea is that just as we provide first aid for physical injuries we need to be able to provide first aid for mental health emergencies.  At first glance, the course looked like it was very much for people not already involved in the mental health field, but it looks like it will be a lot of professionals, which I'm excited about.  I love meeting other people working in the field, hearing their experiences and being able to network.  

I'm also excited because I feel like it's going to be a great refresher.  I took crisis intervention my last semester in school and ASIST (applied suicide intervention skills training) last april, but it's been quite awhile since I've had any official training.  Put simply, I'm excited to go back to "school".  

Other things I'm looking forward to include the break from the office and being able to walk to the course instead of having to drive.  Also, the fact that I get to leave 20mins later then I usually do!  

I'll post a review of it once it's over!

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). 

after the intervention

I've changed my mind about ASIST (Applied Suicide Intervention Skills Training). It is useful. I used it yesterday. And I was surprised...the method worked. I didn't think it would.

The problem with ASIST though is that it's suicide first aid. There's no aftercare, it's all about referral, which is fine. But when people already have community supports, then it's hard to refer them to community supports. I mean, you tell them to go see their therapist and follow up with that, but aside from that, there's not much you can do.

Part of ASIST is having them promise you to stay safe for a set amount of time of their choosing. If the person picks a week, that's great. When they pick one day, but don't have a therapist appointment for a week, that's harder. You talk to them after a day, they say another day, do you do it all week? The model would say so... how realistic is that though? Plus, you're supposed to go through the whole intervention again... that's really redundant. In this case, I just made another safety plan with the person and arranged another check in time as well as reassessed for risk. Thankfully there was a lower risk then the day before.

There is no easy answer in cases like these. There are always options (calling mobile crisis, getting a form two and having them forcibly assessed, calling 911, involving the persons other supports), but there are still no easy choices. How much do you put on yourself, how much do you transfer to others. Ultimately though, it's the persons life. Whatever happens, it will not be my fault (or at least I keep telling myself that).

second day

Despite the corny picture, the second day of my workshop went really well. I actually enjoyed the role playing we did, which is surprising in some ways because really, it's role playing. Worse then just role playing, it's "fish bowl" which is role playing in front of the entire group and then getting feedback. I've never really been a huge fan of it, however it is a really good learning and teaching tool. ASIST gives a really great framework for suicide intervention with "handy dandy" steps and diagrams to follow which makes it a lot easier and a less daunting task then one might think. On the whole, it was a good workshop, and I would recommend it.

all that emotional touchy feely stuff.

Today was the first day of my two day Applied Suicide Intervention Skills Training (ASIST) class. Basically, it's a $250 course so I can get the five letters that will let me get the job I eventually want (working in Mobile Crisis). I had a hard time sitting still long enough today. The course is 9-4 and even though there are lots of breaks, I found it hard. By the end I was swinging my legs and rocking back and forth. I did apologize to the facilitator because by the end I was feeling pretty rude. Bah. sitting.

Anyway, the course itself isn't as bad as I thought it would be, and I tried to go into it with an open mind. It's a little too personal for me though, and a friend of my father's is in it which is just really awkward. I don't quite feel like I can talk about my experiences or the experiences of my family as freely when he's in the room. But that's okay.

There really hasn't been a lot of new information, although I really like the way they write the model out. Tomorrow we get deeper into it as well, and so hopefully there will be some new content. It basically follows the six step crisis intervention model I use, with a couple variations which make it specific to suicide.

Something I really liked about the last suicide prevention workshop I did was their emphasis on how normal suicidal thoughts are, and how so many people have suicidal thoughts over the life time. This course really seems to focus on suicidal thoughts as a bad thing, when I do believe they can be a coping mechanism to get people through hard times. Sometimes knowing there's that way out is enough to keep someone going. Further, this course refuses to acknowledge the fact that there are some people who are going to die by suicide no matter what we do to intervene. And by we, I mean "systems" in general, not just "me" as a person. The other workshop was really good about that and I think it takes SO much of the pressure of the helper; whoever they may be.