Friday, March 19, 2010

Overactivated

Yesterday was a difficult day. I had to spend about 90 minutes trying to rearrange my schedule to enable me to see various clients from different referral sources, who all have different times they must be seen per month and all have different treatment schedules. It was very frustrating; I was completely frazzled. Did not put me in a good frame of mind for my early recovery group.

Usually this group is a good one. But today it was too big and too rambunctious. The agency branch I'm in now allows counselors to pop a non-group client into my group so the client can make up for a missed session earlier in the week. Yesterday one of the most rebellious, obnoxious, and resistant clients was there -- along with one of the most narcissistic, self-pitying, monopolizers. And they fed off each other.

I felt like I was a first-grade teacher trying to keep order. I had to keep reminding them that they can't leave group (if you need to go, make sure you go before group), you can't look at your cell phone, you can't interrupt, you can't have side conversations, and you can't get up five minutes before group is over just because you feel it should be over.

The clients didn't seem to notice how annoyed I was, or the depths of it, because I was able to keep a jocular demeanor. Maybe that was the problem. By the end of the group, I was fed up, especially with the most obnoxious client. I went to speak with his counselor afterward, who was appalled and promised to impose dire consequences -- he'll probably have two more weeks added to his treatment schedule. (Not the first time this has happened.)

But I was so angry and frustrated that I couldn't even sit down to write the group note. It made me question whether I'm capable of doing this work, or whether I shouldn't be a clinician at all if I can't keep my emotions under better control.

During group one client had talked about using marijuana to cope with stress. (To his credit, he admitted that wasn't the best course of action.) I asked the group, "What else could Ellis have done to manage his stress?"

"Have a drink," said one client. "You're less likely to get caught." (Alcohol exits the body in 12 to 24 hours; marijuana can linger up to 30 days.)

"Really?" I asked. "Is that a good idea, group?"

"No, it's not," said one client, Jesse. "Alcohol is still a drug."

That was a small moment of triumph.

"Okay, so marijuana is out, alcohol's out," I said. "Any other options?"

"Take a shower," said Jesse. That led to a great discussion: one client spoke about how water is soothing and (according to some Eastern traditions) healing, and I discussed distracting yourself from unpleasant thoughts by activating the sensory areas of your brain. The more you feel the water on your skin, the less you focus on the thoughts that are bothering you. (It was difficult getting this information out because the obnoxious client kept interrupting, engaging in side conversations, and talking back to me when I tried to rein him in.)

So when I got back to my office, steamed, I put some gardenia essential oil on my wrists and inhaled -- aromatherapy is essentially a sensory distraction. Didn't work; I was still shaking with rage. So I got up and went to a local store to try to buy JV some cologne for his birthday. (Since we don't have a shower in the office.) But all the samples were out of reach, and I didn't feel like asking anyone for help. I really didn't want to talk to anyone.

The rest of the day was a little better, but I was still thrown and overactivated. During clinical meeting and client sessions I kept wanting to talk, talk, talk, pontificate. I also wanted to engage in "professional use of self" during individual sessions -- i.e., talk about me in ways that are relevant to the clients. Except our agency expressly forbids personal disclosure.

Early warning signs of? Hypomania. The time changed five days ago, and already my seasonal affective disorder has flipped. Crap.

I should have walked more on the way home -- taken the subway to a more distant stop from my house. But I didn't. And last night I couldn't settle down. I ate some yogurt; calcium is a natural muscle relaxant and can be calming. Didn't help. I watched some funny sitcoms, hoping to release the energy through laughter. I laughed heartily; I was still energized. I watched some porn, hoping to release energy another way. Still couldn't settle down and go to sleep. Finally I took some Vitamin K. Unfortunately, that worked beautifully.

This morning I'm going to walk to a further subway stop, aching knees or no. And I need to keep a tight rein on my irritability and garrulousness. I don't want to develop a psychological or physical dependence on Vitamin K.
Copyright (c) "Ayelet Survivor"

3 comments:

  1. How are you feeling after sleeping over shabbat? Is your bronchitis in check? I am glad you are being cautious about the klonapin. Hope this week is calmer.

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  3. Better. The bronchitis is mostly gone, I got a lot of sleep. This week should be a little easier, although I'm winding things up before my 7 (work) day vacation. It was just a hectic, hectic week, and hectic activity tends to turbo-charge hypomania.

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