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.

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.

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.

 

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!  

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). 

Homelessness - The Soloist

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!

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".  

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! 

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!!!