I have discovered that posting about MS has its limitations.
How many times can you talk about what a drag it is to not be able to go shopping? So, while this blog will remain primarily a place for me to have a forum for discussing life with multiple sclerosis, I think it will be a lot more interesting if I talk about life as a therapist. My life may be slow and boring, but being a therapist and getting to know my clients is a lot more interesting!
I really want to talk about what it's like to be in the process of doing therapy. I know I could talk about diagnoses and what is known as "best practice therapy", but that's a lot less personal and a lot more boring.
I talked a little about countertransference in my last post. So I want to give you know a peek into the head of the therapist in the process of being a therapist.
My very first therapeutic job was as a "psych technician" on the mental health unit of a hospital, which was really just a glorified babysitting job. We were expected to observe patients and see what they were doing, write in the patient charts at the end of the shift, sit with a patient while they were on suicide watch, that sort of thing. But we also got to run some groups or talk with the patients one on one if they requested it.
This hospital had a mixed unit of adults and adolescents. I'd usually worked with the adolescent. I'm sure, in those days, that sometimes it would be hard to tell me apart from the patients. I was just out of undergraduate school which meant it could be as little as four years between me, an authority figure, and the kids on the unit. Of course, at the time, I had no concept of how the clients may be responding to me as a peer rather than a grown up.
With my bachelors degree in psychology, I was barely equipped to understand issues which would land teenagers in hospital psychiatric unit! At the time, there was a diagnosis called Over- Anxious Reaction to Adolescents, also known for us OARA. This is a defunct diagnosis because it's really sort of describing every single adolescents in a way, isn't it? It is likely that most of these kids had anxiety disorders, or depression, or were being abused, or were just engaging in some of the antisocial behaviors that teenagers engage in!
Nowadays, kids who are hospitalized have to be considered a danger to themselves or others, but at the time, I think parents could arbitrarily have their kids admitted for an attitude adjustment or something!
When I think about this job, they're actually at least four or five kids, and some adults as well, from whom I met a great deal about the therapist and patient interaction. I'm pretty sure I didn't do any long-lasting psychological damage to any of them! But I'm not sure that the interactions I had were anything other than just trying to listen to them. A really large part of being a therapist is really listening without judgment. This may have been my first learning experience of what it means to just listen.
It is much easier to give advice or send somebody to a psychiatrist for medication than it is to just listen and make a serious attempt to understand what is actually being communicated.
I think one of the most profound experiences of learning to listen was actually with one of the adults in the unit. When I look at pictures of myself now from that time, I realized how incredibly young I was and how incredibly young I looked! I can't imagine how anyone took me seriously! I look like Alice in Wonderland!
When the patients were suicidal, they are placed on something called "constant observation". This was the boring job of just sitting outside the patient's room and making sure that they didn't do anything to hurt themselves. Most of the time, the patients would just ignore us, but sometimes they would engage us in a conversation. I actually do remember having a lot of respect for the adults. There were a few who were psychotic. One elderly lady, who was obviously a very sweet and dignified woman when she wasn't psychotic, asked me to write a letter for her. She dictated to me "I am being held prisoner and someone is watching me." She then said, "Sweetie, what is your name?" I told her my name was Amy and she said, "Okay. Write this down. Nurse Amy is the worst most horrible f ***ing bitch in the entire world." So, I diligently wrote what she said, addressed the envelope to her son, and told her I would put it in the mail right away.
It would have been very easy to take this personally, or to try to explain to her that no one was holding her hostage. I'm not so sure that colluding in her delusion was such a smart idea, but I certainly could have made things a lot worse by becoming defensive.
Although this was a good exercise in just listening without judging or trying to fix things, there were other times as well when listening without fixing was the only course of action I could take. My inexperience and lack of training were large contributor to learning to listen as a course of action in interacting with the patients. I remember sitting with a woman and listening as she told me that she was powerless to change things in life. I remember trying to get her to understand that she had choices in terms of how she reacted to situations. I can't remember what her situation was, I do recall that it was something that was well within her ability to change. After an hour of attempting to get her to see that she did indeed have choices, and having her continue to tell me that he didn't do what I was talking about, I left her room feeling defeated and worthless. A few of the psychiatric nurses were very understanding with me, and one of them said "It sounds as if you have an expectation that you are a failure if you can't get a client to listen to you and make changes.". That was a statement which resonated for me for a long time! The therapist is not responsible for the changes in the clients. You can only listen, make a concerted effort to understand, and then invite your clients to listen to you while you provide a different way of thinking. The healing part is not in the advice. It is in the interaction.
That is enough for today, and I will try very hard to keep neglecting my blog for so long next time.
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