Staff Meetings...

We had a staff meeting yesterday.  All the staff in our organization.  I can't say I was impressed.  I am NOT good at sitting still for 2.5 hours listening to stuff that is mostly irelevant to me.  Then our executive director was all like "how come the employment people are so quiet".  And well, it's because we simply didn't have anything to say!  The meeting was almost entirely about our residential program which we have very limited contact with.  

On the other hand, the staff for my program has a staff meeting once a week.  It's quick, to the point, and relevant.  I also find them fun.  I look forward to them even.  I know that if I'm having problems or there's something going wrong, I can bring it up at the staff meeting.  We often have food or something.  For example, today there will be skittles.  

Then, every other week we have a client meeting at which we review the status and activities of each and every person in our program.  It is a seriously great way to collect help and suggestions and I great way to make sure that none of our clients are being forgotten about.  So really, it's just the all staff meeting's that I hate... but still, how I hate them.  

On another note, having a boyfriend is time consuming.  The intrepid one came over to watch the next disk of Friends last night.  It was awesome, but it took my whole evening... 

Poems on the Spot

He sits on the corner near my house. 

His sign says 

Poems on the spot

It's his way of panhandling

From his wheelchair

He's a strange man

I've tried for a long time

To break down those walls

Sitting with him

At the Salvation Army

His duct tape covered jacket

Has me asking the question 

Why?

It's cheaper, he says, with a frown. 

But I know where you can get new ones, free. 

Last week he told me, the poem business 

Isn't going all that well

Maybe he's losing his uniqueness

People are too blind to see

He's hurting deep inside

dreamer finds a boy (oh wait, I'm supposed to call him a "man")

You may have been wondering what happeneded to the dreamer over the past couple weeks.  Where have her deeply insightful and thought provoking posts gone?  Well, there is a simple answer, as happens to many of us, the dreamer has found herself a boyfriend who from now on will be referred to simply at "the intrepid one".  He got that name when we were 13 and it's stuck.  So yes, instead of lying on my couch blogging, I've actually been getting out of my house and seeing movies, and eating ice cream.  Although yesterday, we sat on the couch together and watched 8 or so episodes of Friends.  

Things seem to be going well these days.  I have yet another set of antibiotics for the never ending sinus infectiong, but I'm trying to be really diligant about taking care of myself so that maybe this time it'll finally go away!  

Work is going well.  My case load still really isn't picking up that much, but it's summer, and apparently that's what happens.  I've been doing quite a few intake interviews though, which is nice, I LOVE learning people's stories.  

Church is good as well.  And I'm seeing my spiritual director again on Tuesday.  

Sophie Cat is doing well.  She really seems to like the intrepid one, which is good, because it's vital that the two of them get along.  Yesterday she kept a very close eye on him...it was kind of creepy actually.  I think she senses something is up because she doesn't stare at bestest buds boyfriend the same way.  Currently she's sticking her paw in her water dish and licking the water off her paw... she doesn't like to drink the normal way.  

So hopefully more social work posts shall follow soon.  I'm off to get my morning coffee before I go into major caffienne withdrawl.  

What I'm Reading this Week: Bad Therapy

Kottler, J.A. and Carlson, J. (2003). Bad therapy: Master therapists share their worst failures.  New York: Brunner – Routledge.

When I saw the title of this book staring out at me from the shelf I was immediately intrigued.  Bad Therapy?  Who writes about that?  I’ve read many books in which therapists share cases, both good and bad, many stories of those who survived bad therapy, and of course books that bash the entire idea of therapy at all.  Thinking it would be a collection of short stories, I stuck it in my bag for work the next day ready to jump in. 

While it many ways it was a collection of short stories, in other ways it wasn’t.  Kottler and Carlson put together a set of interview questions which they sent to participants ahead of time and conducted a study of sorts, so things didn’t flow quite as well as I’d hoped they would. 

The authors spoke to twenty-two different therapists, and while their biographies were impressive, I have to admit the only one I was familiar with was William Glasser the founder of Reality Therapy.  The therapists had a variety of backgrounds and worked with a variety of theories, which is something, I appreciated about the book.  Further, it was refreshing to hear therapists be honest about the mistakes they have made or were perceived to have made.  Although, I have to admit, most frontline workers I know are readily willing to admit they’re not perfect!

In terms of recommendations, it’s definitely worth checking out if you have any interest in therapy.  At only one hundred and ninety-nine pages it’s a short read, and due to the format, it’s good for reading when you only have a little bit of time.  It’s probably not a great read if you’re looking for something entertaining (which I usually am).  Finally, as I mentioned before it’s presented in interview format rather then as short stories and sometimes the flow seems just a little bit off, so if that’s important to you, probably not a book you’re going to want to open up. 

 

The Service Eater

Most social workers have dealt with these clients.  The clients who have been to every program under the sun and hope that yours will give them that something they need, that one extra push etc…  The question is, what do you do with them? 

Something I’ve noticed, is that many of these clients have a very negative mental filter.  Despite the positive things which may be going on in their lives, they focus exclusively on the negative and seem unable to take the positive into account.  They often seem very genuine and earnest, often citing the bad experiences they’ve had with other social workers/programs.  And yet for some reason, they keep trying again. 

While some of them have tried and quit every program, there are some that are still IN every program.  I recently had a client who was seeing something like six different counselors at once, and wanted to join our program on top of that.  Despite all the counseling, he was definitely not mentally stable and I recommended we put a hold on his admittance.  I don’t think adding a seventh (or however many) service is actually going to do the client any good. 

The thing is though, no one program is going to be right for everyone, and sometimes what people need isn’t so much a program but someone who will stick with them no matter how many times they quit.  For example, if a client has a counselor who is willing to take them back no matter how many times they storm out and find a new counselor, maybe that continuity will help them to make progress.  It’s hard to know though.  Sometimes the thirtieth program is the answer, it’s the one that clicks, the one that works.

Maybe this thought doesn’t have a point? 

What I'm reading this week: Cracked

Pinksy, D with Gold, T. (2003). Cracked: Putting broken lives together again, a doctor's story.  New York: Regan Books.

I'll be honest, I liked this book until I realized who wrote it.  Not being up on popular culture, I didn't realize that the author Drew Pinsky was the doctor on the shows Celebrity Rehab and Sober House.  I find those shows disgusting, as in they disgust me, not that they have gross content.  So pretend with me for a moment, that I don't strongly dislike the author's professional image and we'll talk about the book.

Pinksy writes about his time spent working as on a doctor on the chemical dependency unit of a hospital.  Unlike the model in my city, the unit seems to function as both detox and addictions treatment, with clients moving directly from hospital to sober living facilities.  The book takes us through average days in Pinksy's life following the lives of patients and their efforts to gain and maintain sobriety.

Dr. Pinksy addresses some of the common causes of addiction although he tends to take a somewhat narrow approach.  He is a doctor, so perhaps it makes sense that he pays a great deal of attention to the medical model and
the theory that addiction is a disease.  The book is clear that the way to maintain sobriety is to detox, start the twelve steps, find a sponsor, and stay in a sober living facility.  The author acknowledges no other paths and does not discuss other models of addiction.  He is clear that all addicts come from extremely dysfunctional families and were abused as children. While I don't have any studies contradicting this on hand, it "irks" me that there is nothing else presented.

Dr. Pinksy shows a great deal of self awareness in his writing, spending time discussing what many would term as "countertransferance" (although he does not use that word) and his reactions to patients.  I appreciated that fact that he acknowledged that he had these reactions and they played a part in treatment.  It takes confidence to talk about your awareness that a patient is trying to sexually seduce you and your reactions to this situation.

As for whether I would recommend this book, I'm not sure.  I might, especially if the person I was recommending it to likes Dr. Drew, but my dislike of his TV shows doesn't make me want to.  But, books are what they are.  If you're interested in a basic overview of one model of addictions and treatment it might be a good place to start.  The patients are interesting, and the story is well told.

Borderline Personality Disorder

You know, I’d never really understood the hype about Borderline Personality Disorder; I kind of thought of it as an over diagnosed phenomenon with a huge stigma attached to it. 

I’m starting to get it. 

I have a client with a diagnosis of BPD.  I have one more who meets at least as many criteria.  And they really are hard clients to deal with.  If it wasn’t for the fact that we have a good supervisor, I think this client could have caused a huge stir around here very quickly with a couple accusatory emails she fired off yesterday and today.  Thankfully our supervisor realizes that we actually are doing what we’re suppose to do and has not sided with the client.  Because the staff involved have a good working relationship she has not been able to turn us against each other.  It’s a good thing.

All that being said, I still think it’s an overdosed phenomenon with a huge stigma attached to it. 

Currently, our staff is doing all the right things, and I hope that the client, and us, will be able to learn something from it.  Because we work as a team, we’ve decided to be consistent in the way we approach her and deal with her.  This virtually eliminates her success in playing us against each other.  Further, we had a community meeting with all her service providers (and her mother), and came up with a plan.  We’re sticking with the plan and trying to reinforce it with her.  This means redirecting accusations of “you’re not doing anything for me” to “did you get on the list for this class”? 

It also means ignoring some of her more exasturbating emails and reminding her to come in for her appointments.  This reinforces our team’s boundaries, because from what I’ve read, and what I’m observing, boundaries are going to be everything.  Fighting with her, is obviously unprofessional, but more over, it’s not going to work.  Accusing her of things is not going to help her or us in any way, shape, or form. 

deinstitutionalization

Let me start by saying that I realize I'm touching on a controversial subject.  I'm going to talk about it anyway.  

A few nights ago I was at a meeting about disability rights legislation.  Yay advocacy and policy development!  Anyway, at the end, for the "check out" (gotta love meetings run by social workers...) we had to share a barrier we thought was faced by the disabled community or that we were currently facing.  I talked about lack of adequate access to mental health care, some people talked about attitudes, others about accessability and employment, all the normal things.  What surprised me, was the number of people who talked about institutionalization and how important it was that we continue with deinstitutionalization.  

I'm not sure why it surprised me.  It's not exactly an unfamiliar concept for me, and for that matter it is something our government is currently working on.  Our newest Assertive Community Treatment team was set up to take referrals only from the long term mental health care facility, at least in it's initial stages.  In otherwords, it was designed to be intensive support for deinsitutionalization.  

The thing is, in my experience, institutionalization, in some way, is necessary, until we come up with better options for psychiatric treatment.  I spent eight months doing practicum in Assertive Community Treatment, the most intensive form of community mental health care my province has to offer.  The clients have a team of professionals and twenty four hour on call support.  They have daily contact, sometimes twice daily, observed meds and assistance with just about anything you could need assistance with.  Unfortunately, even with this very intensive level of support it was necessary to make two referrals to the long term care facility during my eight months.  Of course during that time we had many success stories as well.  

See the thing is, despite everything the team was doing, these clients simply could not be maintained in the community.  One woman was living in a rodent infested house with rotting floors, sleeping in a urine soaked bed, the house was in and out with drug dealers and the dirt was incredible.  She absolutely refused to take meds or to move.  Eventually the police had to remove her from the home and the public trustee made the decision to stop paying her rent.  The last time I saw her, she was doing okay in hospital, but certainly not well enough to live out again.  Another was so mentally ill and so drug addicted she jumped off a bridge, thankfully not too high up.  The courts didn't know what to do with her many crimminal charges and once release from jail or hospital she'd disappear for days at a time without taking her meds.  Because of her spinal injuries, she was referred to long term for her own safety.  

And then there are the forensic patients.  We have a special locked ward for them.  And seriously, I've been on the "worst" ward in the long term care facility.  The patients there are very, very mentally ill.  They are affected in ways that I cannot even begin to imagine.  Maybe with time, and patience and new treatments something will change, but until then... where will they go if their insitution is shut down?  

Finally there are the geriatric patients.  I've got news for you, schizophrenia doesn't end with middle adult hood, brain injuries don't magically heal.  And while we do have specialized homecare services, some clients just need more then that.  

So, i do agree with deinsitutionalization.  I want to be very clear about that.  I also don't agree with the institutions of the past, however, I want to make it very clear that there is a time and place in which long term psychiatric care facilities are necessary, and I don't think closing them all, especially without replacing them, will do the community a whole lot of good. 

Spiritual Direction

So this evening, I went for my first session of spiritual direction.  Or maybe that's too clinical.  Perhaps I'll say, this evening I met with a spiritual director for the first time.  It's something a mentor of mine suggested to me when I was so depressed a couple months ago, and that I took some time to read about, think about, talk about, and pray about.  Eventually, I decided to go for it.  I really do want to feel connected with God and to nurture the spirtual side of myself.  

Basically, Spiritual Direction, or at least the kind I'm participating in, is a conversation between two people where the focus is God.  It's comparable to a counseling relationship, but it's far less clinical.  Further, counseling most often has specific goals and such.  Spiritual direction is all about the journey.  If the goal is to feel closer to God, you don't have to know what that will look like, or how you'll know when you're there.  Spiritual direction can go on for years and years.  The director listens, there is prayer, and perhaps you focus on a certain spiritual discipline together.  The two listen for the Holy Spirit and focus on what God is doing in the directee's life.  Often it invovles talking about daily life and recoginzing where God is, being more attunded to the working of the Holy in the ordinary.  

Tonight's meeting was a good experience for me.  I feel comfortable with the woman I found, and comfortable with her background.  She also felt comfortable working with me, and thinks that I'm in a very good place in my life for this journey together to begin.  

So we'll see where things go.  Generally you meet with a spiritual director about once a month or once every 6-8 weeks, however for the first couple months we'll be meeting every two weeks as we get to know each other and I get to be comfortable in her presence.  Spirituality has been a part of my life for a long time, but is something I often don't articulate very well.  Hopefully, I'll be able to articulate some of it here as well as other places. 

long time no post.

I'm still not posting much.  I was out a lot today, no time for writing.  Church, yoga, gelati, dinner, tossing around a frisbee with friends.  Much to do.  

BUT, for those of you who twitter... So does Sophie Cat!!!

Follow her on twitter :)  http://twitter.com/TheSophieCat   

that is all.