Wednesday, April 22, 2015

Full disclosure

Well, more like partial disclosure. I have a client who has some form of psychotic disorder and is currently very paranoid. Right now the only people in the clinic he trusts are a part-time counselor, the program director, and myself.

The part-time counselor is an intern who is very wise and has tons of life experience, but was really just an intern a few weeks ago. So as his supervisor, I work very closely with him and his clients. And one of the things we had to work on was getting this client to go back to his psychiatrist, so we met with him together the day before yeesterday.

This was an interesting challenge because I had to stay very, very calm with the client, as he's easily agitated and I'm ordinarily a live wire. Which usually works in my favor but would disregulate this client. I wasn't trying to argue that he needed medication -- I just wanted him to see his psychiatrist again.

The client currently goes to a community health care clinic that provides all services under one roof. Primary care, dermatology, endocrinology, urology, gynecology, dentistry, podiatry -- one-stop shopping. And the program has a coordinator who integrates behavioral health -- psychiatry and therapy -- with their other services. I know because I applied for that job and didn't get it. (Grr.)

"Going to the psychiatrist is just like going to your primary care doctor or any specialist," I said. "The brain is part of the body."

"Do you go to a psychiatrist?" the client asked.

I froze for a millisecond. Personal disclosure is dicey. Revealing too much information about yourself changes the clinician-client dynamic. It ups the intimacy, which can be a serious boundary violation. You have to be absolutely sure you're disclosing to benefit the client, not yourself.

I reveal very little personal information about myself to my clients, and not just because I have a stigmatized illness. On the other hand, here was a chance to be authentic and walk the walk. If there is no reason to be ashamed of going to the psychiatrist, then I should be honest if I go to one.

"Yes, I do," I said. "I go to the psychiatrist, just like I go to the gynecologist -- and it's a lot more comfortable than the gynecologist."

I was hoping to inject some humor and distract him from asking for particulars, and it worked. "Well, you have to go to that doctor, you're a woman..." he said, blushing and averting his gaze.

So we got him to agree to see his psychiatrist again. And now the former intern is the only person at my job who knows I see a psychiatrist. But I'm pretty sure he can be discreet, because he sees one too. I found that out during supervision. Didn't ask -- he disclosed. Which was fine.
Copyright (c) "Ayelet Survivor"

Tuesday, March 24, 2015

99 problems but insurance ain't one

Something bad happened at work last week. Something really awful, painful, and humiliating. I can't describe it, and it wasn't my fault. But I should have had some supervision about it -- a debriefing, really -- and I didn't. As usual, my supervisor is too damn busy.

So I called our Employee Assistance Program, shaking, and asked for assistance. And learned that you can get three free therapy sessions to deal with an issue, assisted by the therapist of your choice. (As long as the therapist accepts the insurance. You have two sessions to decide if you think the therapist can help you.)

"Here's your authorization number," said the quiet-voiced EAP rep. "It covers the first three sessions, After that, if another issue... emerges... the therapist can call us to request reauthorization to deal with the new issue.

"It's not like you can't talk about former issues after a reauthorization," he reassured me. "But as long as there are new issues to discuss, the therapist can keep calling to request more coverage."

Essentially, as long as you've got a new issue to list, you've got at least three more sessions. It took me less than 15 minutes to come up with:
  1. Last week's horrifying event
  2. My mother and her degenerate pervert boyfriend
  3. My sister rejecting my Facebook friend requests
  4. Being overworked and overstressed to the point where I get fired from jobs
  5. Being racially harassed by the jerk who said "I think you don't like me because I'm black"
  6. Being written up for writing "ax" instead of "ask" in a progress note (I was quoting the client)
  7. Having my knees wrecked by that personal trainer and the horrific commute
  8. The constant emergence of new bipolar symptoms. Most recently? Terminal insomnia AFTER daylight savings ends. Traditionally that's when the terminal insomnia has ended.
  9. Being single, childless, and middle-aged, with no home and no family
  10. Always feeling like I'm on the verge of being fired from my job, because I have been fired from so many jobs.
  11. Losing my religious idenitty.
  12. Having burned so many bridges in this town, including at The Bad Place.
  13. Needing to learn how to supervise people to do what I want them to do
  14. Losing my father when I was young
  15. Taking almost everything much too personally
  16. My explosive, ever-ready anger
  17. My weight and dislike of dieting and exercise.
As Al Pacino said, I'm just gettin' warmed up. Any suggestions for what issues I might also need to tackle? I showed my psychiatrist the list of therapists EAP sent me. She recognized one name, and I will call -- and Google -- that person. Soon.

Copyright (c) "Ayelet Survivor"

Wednesday, March 18, 2015

Deja vu all over the now what was I saying?

Yesterday I clicked "interested" on a gentleman's Jwed profile. He seemed attractive, nice, interesting, age-appropriate. Today I got an email from him:

Hi, We went out last year. It didn't work out. Good luck finding a match!!

I have absolutely no idea who he is or what happened on the date. No. Idea. Either I've repressed the memory or I'm entering dementia. Or, more likely, I've been dating so fucking long, almost everything is a blur, with flashes of painfully clear awful incidents.
Copyright (c) "Ayelet Survivor"

Tuesday, March 17, 2015

She thinks a little too highly of me

Not a lot of social workers have their LCSW and CASAC. If I were fluent in Spanish, I'd be a unicorn; as it is, I still receive expressions of interest from recruiters at least twice a week. I had a fight with my supervisor and actually called one back a few weeks ago and went on an interview, but the job would have involved working with entitled adolescents, a population I doubly despise. I like working with underprivileged adults, preferably with comorbid substance abuse and psychiatric disorders. What can I say? I like a challenge that doesn't sneer, "That's so lame" or whatever the kids are saying these days..

Anyway, this morning I got another message from a recruiter:

I found your resume on [social work job site where I haven't bothered deactivating my resume]. Please reply to this email if you are interested in discussing the following job opening:

[Placement agency I've never heard of] is seeking a Regional Director of Clinical Services for a full-time permanent position located throughout NY. As director you will develop and implement clinical programming, staff training, and prepare financial plans. This position does requiring travelling to multiple locations in New York. An office may be set up in any of the boroughs or Long Island according to your convenience.

REQ:

  • Master’s Degree in Social Work or related field, psychiatry, psychology, and medicine
  • Licensed Clinician in NYS
  • 10 years of leadership experience preferably in substance abuse facilities
  • Knowledge of OASAS

Please contact me if you are interested!!

Well, I have a master's in social work and I'm a licensed clinician.in NYS. I know OASAS fairly well. However, nowhere on my resume does it state that I have 10 years of leadership experience anywhere. I have about eight years of clinical experience if you include my second-year internship. Of that, three years constitute clinical supervision, and I have about 10 months of administrative supervisory experience. And my performance at my last job wasn't exactly a stellar success story.

I'm definitely not going to respond; I'm no longer mad at my supervisor, and I'm nowhere near qualified for this position. Why on earth would she contact me?
Copyright (c) "Ayelet Survivor"

Friday, February 06, 2015

How to lose a guy in one text

At work I seem to have developed a reputation as a hardass. Today one of my counselors asked me if it was true that I call HR at the main office when people are late.

Much as my German half would find that infinitely satisfying, I don't. I'm not sure how the rumor got started. My supervisor is much better than I am at dealing with people's peccadilloes. When an intern lies to me or a counselor messes up, and I have to deal with them, it doesn't seem to touch her. She tells me what needs to be done and I do it -- but the way I do it, apparently, isn't tactful enough.

It's strange, because when I had to write someone up for doing something monumentally stupid, I agonized. I flashed back to all the times I've been written up. (Well, three times, once at each job after social work school.) I felt horrible addressing the behavior, and I tried to be as supportive as I could. When the counselor followed up that monumental piece of stupidity with an egrigious display of unprofessionalism, I didn't do a formal writeup, just a supervision note.

And yet, the people I supervise are rumorizing about my rigid and punitive punctuality..

I need to work on that. Yes, I know I'm supposed to be finding a therapist, but my schedule is still not final; we need to hire a few more people so I'm not working so many late nights. But it's only been two months and already there are hurt feelings. Some are not justified, but some might be. I thoguht I knew how to balance supervision with friendliness.

Part of the problem miight be (I hope) that I'm not getting regular supervision. My supervisor has been promoted; she's only staying until she finds a program director to replace her. In the meantime, she has a bazillion new duties. So she's often not around. Today we finally actually sat down to talk about how things are going.

"If I thought there were problems, I would not leave you hanging, Ayelet," she said. Apparently she thinks I'm not broken and don't need much fixing. Which is a relief. But I still think I really need more supervision, and I hope they find a cool program director soon.

As at work, so in dating. I am a bull in a china shop.

I haven't been blogging much about the guys I go out with, largely because I think that's healthier. But there have been several:
  • The brilliant, damaged engineer, who was so much fun to talk to until he told me he would never, ever, ever consider getting married again. It was great to feel so attracted to someone, to have that excitement and chemistry, to conversate like Cary Grant and Rosalind Russell in an old movie -- but after two glasses of wine on our second date, the awful truth emerged. I could have sworn he'd said on our first date that he was open to remarriage and possibly a baby, but he didn't have as much wine that night. Buh-bye. After Ivan the Terrible, I should have forever sworn off divorced engineers.
  • The disheveledly balding, bushily bearded guy, who wore a hoodie and dirty jeans and made me hug him hello and kissed my head. I could feel the wires of his beard press into my scalp. I've never been a fan of facial hair, and his beard was not attractive. Shave and a haircut, anyone? He wanted to go out again, but when he tried to hug me goodbye, I cringed and he looked stricken. "I'm not much of a hugger..." I offered feebly. He never called again, which was mostly a relief.
And then there's a guy that I was supposed to go out with again, but maybe I won't. Because he sent me a few cute texts, and I sent a horrible one.

He's a single dad. Child lives with him. So we went out on one of his non-custodial Saturday nights, a week ago. I thought we had a decent time, although he looked significantly older and scruffier than his profile picture. But he asked me on the date if I wanted to go out again and I said yes. We made plans to go out again on his next non-custodial Saturday night, which is a week from tomorrow.

Yesterday he sent a text:

I'm in an excruciatingly boring meeting. Please do not send me racy texts or I might burst out.

Ironically, I was in a fairly boring meeting myself and I didn't have my phone with me. So he texted again:

Unless you want to torture me with an unprofessional giggle attack.

I was still phoneless in my own meeting.

Meeting over. Resume arousing messages.

This guy is smart and funny. When I left work, I texted him,

ROFL... Sorry I missed this!

He responded quickly

There's no shortage of excruciating boredom. You'll have another chance.

And what did I think? He'll text me when he's bored and has nothing better to do. How flattering.

And very stupidly I texted,

How flattering.

Dead silence.

Why, why, why do I do such stupid things? I think better of it and I do it anyway! Stupid stupid stupid!

This morning I tried to muster some damage control

Sorry, that came out a little harsh.

No response. I called and left an apologetic voicemail -- said something like, "I'm sorry about that last text. It was... silly."

No response.

So I don't know if I have a second date with him. That's how Ayelet loses a guy in one text.
Copyright (c) "Ayelet Survivor"