the benifits of boundaries

I recently had a client come into detox who I really liked. I like most of my clients, but this client was different, I could totally have been friends with her if we'd met in a different context. We're close in age, live very near each other, frequent the same places, are in similar income brackets, similar levels of education etc...

It was an interesting experience, because I got to see how beneficial good professional boundaries are. On a slow night in detox I sat down at a table with a few clients making beaded jewelry to try and talk to them in a non threatening context. The others cleared out and the client and I wound up having a really great talk. It started on the outer level and we were probably contributing about equally to the conversation. Suddenly it occurred to me; "shut up, it's about her". Best advice I could give myself. After I started really listening, reflecting, and asking some open ended questions the conversation began to move from the outer level to an inner level and we were able to talk about some deeper stuff. In fact, she came and found me in the office to talk more later, bringing up some other personal stuff. It was a really great reminder of paying attention to context and really listening.

It also made me think about my job. I spend a lot of time doing laundry, cleaning IPDA cells, and driving people around, oh, and I wash I lot of dishes. Further, a lot of my clients are pretty much permanent residents of the shelter and have no current desire to change. I have skills to help people make changes. I took a whole bunch of counseling classes as part of my BSW and while I use my "attending behaviours" all the time, I rarely get to use much theory working in the environment I do (I mean, theory is part of everything, but not). I like what I do. I like that I'm comfortable there. I just know that I could do so much more. Maybe that's a bad way to look at it though. Maybe I just need to figure out a way to use my gifts and skills with this population I so much want to work with. Thoughts for a day when I've had more sleep...

more about sleep (or lack there of)

I realized that I have more blogs labeled "sleep" then I do "social work" in my blog about social work... interesting. I wonder if there's a hidden meaning there.

In any case, my schedule is pure evil for the next week. It started Friday. I did street ministry starting at 6PM and then worked from 11:30-8:00AM. Then Saturday 11:30-8AM Sunday morning. Then church, then a 1 hour nap and then back to work for 3:30PM - midnight. Bah. I now have two days off though, which is very needed after being at work 17 out of 24 hours and only getting an hours sleep in between two eight hour shifts. Then starting Wednesday I work Day, Night, Evening (again with only 7.5 hours between my shifts), Evening, Night. Oh, and first evening there, I booked off, so I could be at street ministry. Yeah right apparently. I called and complained, but if there's no one else to work it...

Oh well. The other staff are really supportive, well, some of them, and I'm young, lol, I should bounce back. My stomach is not too happy with me today though, so hopefully it gets a little more normal feeling tomorrow.

the end.

sleepy little social worker

With my job the way it is, my doctor has given me permission to sleep as much as I want. Or well, I was kinda worried about just how much I've been sleeping, and she said it was okay, just sleep when I need to.

The past two weeks, I've had a heck of a time dragging myself out of bed, no matter what time I'm trying to get up for. I just don't want to wake up, and then despite the fact that I'm tired, I can't sleep. High anxiety, random hyperness, you name it, I have it. Yesterday and today were my "weekend", and now somehow my body wants to sleep properly.

I'm working nights starting tomorrow, for at least two days in a row, so I need to be on a night schedule. I tried to stay up late last night, and only made it till 3AM. I woke up at noon. Which is nine hours sleep, but lately I've been having to pry myself off the pillow at 11:30. It's only just after midnight now, and I'm having trouble keeping my eyes open. Bah. I REALLY need to sleep all day tomorrow. I need to sleep till like 3 or 4, because i have street ministry at six and then work at 11:30. If I wake up before 9, I'll wind up being up for 24 hours straight, and I just don't like doing that.

So here's to me staying up till sunrise! (yeah right).

I'm a what what worker?

I had a job interview a week ago for a full time nights position as a crisis worker at the shelter where I work. The interviewer asked me how it fit with my overall plan as a professional. I gave him a quick answer about how I'd be there for at least a year, and how I wanted to get my MSW at some point, but it got me thinking about what exactly a social worker is and whether I'm doing "it" or not.

Most people think of social workers as worker in Child Welfare (DCFS, CFS, CAS etc). Other people think of social assistance or housing when they first hear "social worker". In fact, while social workers do those things, they also work in hospitals, clinics, geriatrics, schools, counseling centers, crisis lines, large companies, health care services, insurance agency, shelters, churches, and well, pretty much everywhere. Social workers are often part of multidisciplinary teams working in palliative care, aging, and mental health as well as education. As a student I learned as much from the psych nurses and occupational therapists on our team as the social workers, if not more, about working with serious and persistent mental illness.

I tend to think that social work is more of an attitude then a profession title. When I did a practicum in mental health, the nurses, occupational therapists, and support workers were all "social workers". Some people in the profession would get upset with me saying this, but I believe it to be true.

Social workers are people who look at situations holistically. We consider the whole person, the biological, the psychological, the social and the spiritual. We are people who realize that problems do not exist in isolation. It's very important to consider a persons entire "system" when looking at the health and mental health. Whereas some people see health as simply biological, or depression as a person struggle, social workers work to see the entire picture and all the factors that contribute to personal well being. Social workers go beyond the person and pay attention to the political and systemic issues at work in situations. We advocate for social justice and policy change. Social workers are advocates. We help client's work their way through society's systems, to understand, and to have their rights fulfilled. We interact on a sometimes daily basis with nurses, doctors, lawyers, advocates, parents, children, families. We are people people (well except those who work in policy analysis and stuff, but that will never be me. And even then, they're doing it for people).

So is my job now social work? I would have to argue that it is. Though I work a lot of nights, don't carry a case load, and am called a "crisis worker", I am still a social worker. I care about people. I realize that though they are coming to a shelter they have greater needs then food and shelter. That being said, I also realize that though they have other needs, it can be hard to work on things on an empty stomach with no sleep. I realize that winding up in the drunk tank is more then personal failure and yet client's need to take responsibility for their actions. I understand that our chemical detox unit is both an end and a beginning. I recognize that in order for things to change there must be change in society as a whole, and yet I recognize that change must come from within. I have realize that I have huge power to effect change and yet I realize that I can't do everything.

In my job right now I have the opportunity to make a difference in people's lives. And that, is what I think social work is all about, no matter what area of the field you are working in.

detoxing from what? and/or what doctors should talk to their patients

We run a "non medical" chemical detox unit. This means we don't have any medical professionals on staff. Before a clients comes in to detox they have to get medically cleared by a physician (or nurse practitioner) and have their medications listed on their medical clearance form. When they come to book their intake appointment they have to have all the meds on the form and enough to last them 10 days.

I am continually amazed at how many medications my detoxing clients are on. And yet really, it makes sense. Long term substance use creates medical problems. These require medication. Psychiatric problems and substance use goes hand in hand, these require medications. And many nice doctors will prescribe a benzodiazapine to help with the detox process. Again, pretty normal. But it still surprises me.

What makes me mad however is the number of clients who have no idea what they're taking or why their taking it. We dispense client medication as per their prescriptions, and I can never get over how many clients are clueless about their meds. Many of them only take their meds on a regular basis when they're in detox, but still, it bothers me (and reminds me of another subject which is the starting and stopping of psych meds).

A couple days ago a young woman and her mother came in to get the girl into detox. She had a prescription (not yet filled) for olanzipine. Olanzipine is a fairly heavy duty antipsychotic. From what I know and have observed, it's generally not prescribed first...especially when the patient is not psychotic. But whatever, I'm not a doctor and have no medical training. What bugged me, is that this girl and her mom had NO idea what the medication was. None at all. Her mom thought it "might be like valium". And that was it. I can't imagine going to the doctor, getting a prescription and then taking a medication without knowing what it was supposed to do! And with all the potential side effect of olanzipine, starting it while detoxing has got to be hard. The two asked me if I knew what it was, and i started to explain, but realized I shouldn't be explaining this, I'm not a doctor, I'm not a pharmacist, they need to be talking to someone who knows.

Bah. I have so many clients like that. We have this program where I live called "It's safe to ask", which is supposed to encourage doctors and patients to talk to each other; in particular about medications. I guess it didn't work in this case!

ps. just cause someone uses crack doesn't mean they're psychotic when they're not on it!

sober v drunk

Sobriety is an interesting thing. So is intoxication. As is the difference between the two of them. I find it especially interesting the different decisions people make when they're sober vs when they're intoxicated and how this is different for different people.

At work, we have rules about sobriety and detox. Basically, you have to be sober for every step of the process but it doesn't matter if you're intox in between. You pick up your medical form while sober. You bring it back and book an appointment while sober. You go to your intake appointment sober. Plain and simple. Some people are so caught up in their addictions that this is very hard for them.

The reasoning behind it, is of course that you can't make rational potentially life altering decisions while you're intoxicated, which makes sense. On the other hand, some of the people I work with really aren't ever fully sober until they've been in detox a couple days. It takes a long time to dry them out of the almost constant supply of alcohol and solvents. I had a woman in IPDA once for eight hours, and she said it was the most sober she'd been in 3 years. I'm fairly sure she was heading home to drink.

Another interesting thing, is that some people only want detox when they're drunk. When they're drunk they're saying "give me a form, give me a form", which we don't, but once they're sober they're like "oh no, forget it".

Really, what is intoxication anyway. Is it a blood alcohol level of .08? Or is it different. Is the client who is partially intoxication all the time really intoxicated? Or is that just who they are. Or is that a very cynical way of looking at the world. One of our regulars, who I really don't think I've ever seen sober, was supposed to be heading into detox tonight (he's more excited about the free meals then detox at this point though I think). I'm very interesting to see if he sticks it out and what he'll be like in a few days if he does. I'm sure he's been there many times, but I've never seen it, and I'm interested to.

I'm too sleepy to be blogging, I bet this doesn't make much sense at all... sometimes I just need to write though.

I <3 HP

My black cloud is still following me around today, but there were some definite breaks for sunshine. Mostly though, I just want to be miserable about not getting that job and curl up and do nothing. So, I will. For a couple days. Then I'm getting over it and moving on. One will come up eventually.

In any case though. I did have a fun story for today.

Everyday after we serve our 1:30 soup we put on a movie. I'm sure we're breaking a million laws by doing this, but it's what we do. I can pretty much guarantee the movie theaters aren't losing revenue by us doing this. We only have a limited number of movies, and it seems that the clients have seen them over and over and over again. Further, most of the movies we have are violent, bloody, gory and loud. This is what people seem to be into, but I can't help wondering if it contributes to some of the violences and loudness inside the drop in.

So, today I brought Harry Potter I and made them watch it. Most people filtered out after soup like always, but this one guy was just enthralled by the movie. It was very cute. He's an older man, not very well spoken, heavy drinker/solvent user, but he has the cutest smile. He grins at me every time he sees me and it makes me grin too. Anyway, I tried to talk to him, but he was busy watching the movie. "Funny movie" he says pointing at the screen. While I've never thought of the movie that way, I'm glad he did. And, it was nice not to be listening to explosions and gunshots while trying to get work done.

Next time I work in the afternoon I'll bringing HPII and so on. After that, I'm thinking RENT. And well, that's basically all the movies I own, so I'll have to hope some other staff will bring in some quieter ones. Or maybe not. Maybe if that's what they like, that's what will watch. I just can't help thinking it's a bad idea to watch so much violence on such a regular basis.

Juxtiposition of Reality part 2: Why I don't care about the new iphone

Most of the time I go about my day to day life and just sort of take certain things for granted, reality for instance. Every now and then reality steps up and smacks me in the face. For example, my favourite blog, Shrink Rap, has been talking about the new iphone. But they're not the only ones, a lot of people I know are quite excited about the iphone coming to Canada and the new iphone in general. And I got to thinking about whether or not the iphone would have any impact on the people I work with, and what they would in fact do with an iphone. This made me laugh, and I thought I would share some of my laughter with you. It was also hard, and I thought I would share a piece of my ongoing struggle with society as well.

The thing that comes to mind is how amused some of the people at work would be by the "etch e sketch" feature. Many of the people I work with have had permanent brain damage from sniffing and drinking various solvents and non-potable alcohols. They no longer function on the same level as most of society around them, and I think they might find this amusing; particularly while intoxicated.

The second image in my head was of a sudden influx of drugs into the poorest part of town and a new breed of iphone carrying drug dealers. People will sell anything to get drugs, and I'm pretty sure most people wouldn't be able to hang onto something this valuable for long. Not all drug dealers use drugs, so it's a little easier for them to hang onto their possessions.

Then I thought about what a different place the drop in would be if everyone sat around listening to music with ear buds. One of the greatest things about work is the sense of community among the people, and I think something huge would be lost of everyone was off in their own little world all of the time. There might be less fights, but I don't think it would be worth it to lose that sense of community.

I also considered the fact that many (but not nearly all) of our clients are illiterate or computer illiterate and how this might impact their use of their iphones. On the other hand, this might be a great teaching opportunity, and a chance to give people some marketable skills. Besides that, it's a whole lot easier to get a job if you have a phone! People could call them for interviews, set up meetings etc... And think of the opportunities for them to use the internet to connect with the outside world!

But the thing is, no one is going to come around giving my city's homeless people iphones, and if they did, it would be a huge waste of money. There are so many more beneficial things we could do with the money; like provide vegetables, and a larger, less crowded space to sleep. How great would it be to never have to turn away a cold, tired, hungry person! Or maybe, instead of having a sock exchange we could give out brand new socks each time; or at least not wash them quite so many times.

And this is where I get hung up. There are people suffering, and the money invested in creating the iphone could have been spent in dozens of different ways to work to alleviate suffering, but I don't think that makes the iphone bad. In fact, I think it's kind of cool, and if anyone I know ever gets one, I'll definitely be "etch e sketching". So sometimes, instead of trying to reconcile those two views in my head, I just don't. It's sort of like, I care so much, that I can't care, because it would be too hard, and then I wouldn't be able to care as much.

So, I don't care about the new iphone. It's just easier that way.

the other reason I'm in a bad mood

It occurred to me today that even though I'm riding my bike and eating less, I'm gaining weight. Not a lot or anything...but enough that I shouldn't be. So I took a look at what it could be, and discovered the culprit.

Starbucks Pumpkin Scones.

I wouldn't be surprised if I ate three of these a week. And they come packed with 500 freaking calories and 20 whole grams of fat... oops? So to add to my bad mood, I have to cut back on my favourite food. They have very little actually nutritional value.

Turns out the drinks aren't so bad. A light grande cafe vanilla frapucino has under 300 calories and less then 3 grams of fat. Of course, they're bad for my budget, but at least they're a source of calcium. And calcium is good for you.

But sigh. I LOVE pumpkin scones. They are so yummy. Rich, thick, tasty. Alas, woe is me, my indulgence must come to an end.

this was going to be happy

I have many happy things I want to post about. I really do. But right now, I'm in a bad mood. A black cloud has hung over my head all day. I didn't get the full time job I wanted at work, so I'm still stuck on random crappy shifts. I have no sense of permanency and still get all the stupid jobs. I get the "next position", so who knows when that'll be. And my boss told me right at the beginning of my shift, so I had to work the rest of the day pretending I wasn't frustrated and upset. But, I sure didn't stay for overtime today.