Wednesday, November 20, 2013

Depressed therapist wearing pretty big shoes.

One of my patients is brilliant. IQ measured at over 150. Attended an Ivy League college on full scholarship. Before he was thirty, he owned his own home and two luxury cars. And then he discovered heroin.

His fall was the stuff of Greek tragedy. His recovery was interrupted by numerous relapses and took decades. But he's finally established some abstinence and will soon enter a drug counselor training program. He'll be good at it, and that's fortunate, since it's his only option. With his prison record, he can't even get a job at Trader Joe's.

He likes to talk to me. I don't really have time to manage an ongoing therapy caseload, since my primary responsibility is working with the counselors, but I make time for this patient.

(If I may be allowed to brag: when I was brought into the clinics, their October 2012 audit granted them a one-year license, which is not good. In October 2013, one clinic got a two-year and the other a three-year, which is the maximum amount. And the clinic that got the two-year license was audited by a woman with an ATTITUDE who made several factual errors. We pointed this out to the administration, but I don't know if they're going to protest to the licensing agency. But that's beside the point: That is how hugely I improved the clinics.)

I'm damn good, even when I'm coping with chronic pain and bipolar disorder. I'm muddling through some mild depression right now, and it makes therapy difficult. Because when giving therapy, you have to be completely present and in the moment and responsive to everything that's being said (and not being said). I can do that, even when depressed. What I can't do is remember everything I say and everything the patient says.

This is annoying, because today I apparently said some pretty awesome things. In reflective listening, you don't just repeat back what the patient says. You also summarize from time to time, and you respond to unspoken cues, like expression, tone of voice, body language, etc. One of my summaries was so good, the patient said, "That's exactly it. That's me in a nutshell."

And I have no idea what I said.

Well, that's not strictly true. I remember the basic topic we were discussing. This patient ruminates frequently on the kind of philosophical questions that have bedeviled great thinkers for centuries: why are we here, is there a God, the meaning of life, etc. I think I noted the difference in him now versus last year, when he was still using. Today, he thinks about these questions and other unanswerable issues in his life, and, not surprisingly, doesn't really find definitive answers. Not knowing the answers bothers him, but not as much as it used to bother him, when he would become frustrated and enraged and relapse. He has accomplished a great deal of acceptance, which was very hard-won in his case.

I know I'm doing a good job because he's very eager to participate in therapy with me. This is an enormous compliment, because he used to be in therapy with one of the most prominent forensic psychologists of the 20th century, who worked in the prison where my patient was incarcerated for several years.

Dr. Bigshot wrote articles and textbooks that I studied in graduate school. It's like Albert Einstein was my patient's physics tutor. So if I were an incompetent therapist because of my depression, my patient would be able to tell. That he keeps coming back for more is a huge compliment.

I'm just annoyed that my brain isn't working as seamlessly as it does when it's not depressed. It's like rusty machinery, grinding and sticking at times. I grope for words and phrases much more often. I have trouble explaining what I'm thinking. Blogging is very difficult.

So is interviewing. Two days ago, I had a very strange group interview with three people. Did I say interview? I meant interrogation. First about my current job -- why it's structured the way it is -- which I thought I explained adequately but then was asked about again. And again. Then about my 3 greatest weaknesses and failings, how I manage conflict with others, do I sacrifice kittens to Satan, etc. (My depression is probably imposing something of a negative cognitive bias on my recall of this interview.)

I don't think I'll follow up with them; it was a very uncomfortable vibe. And it's probably moot, because they didn't seem very impressed. If I weren't depressed, they might have been more impressed, and I don't think I would have been so exhausted afterward.

Today I had a much better interview at a much better agency, which has just opened up a new outpatient clinic. They seem to respect their employees, and I'd be doing only psychotherapy, which would probably be a nice change from wrangling uncooperative supervisees. I liked the assistant director I interviewed with, and if they take it to the next level, I'll meet with the director and several of the other clinicians. Hopefully not all at once.

I've also been networking with Professor Supportive, one of my favorites from social work school. She works part-time at a very prestigious psychiatric institution, where I sent my resume several weeks ago. Despite the recent decline and passing of her mother, she and I have been in touch, and she's going to reconnoiter at the institute the next time she's there, to see how their hiring process is going and throw in a good word for me. I'm pleased that she remembers me fondly, and glad I sent her a condolence card.
Copyright (c) "Ayelet Survivor"

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