In a crisis counseling setting, it is essential for the staff to be happy, positive, fun, and at times even outrageous. All these apply to our staff Psychiatrist Dr. J.
Dr. J stands six foot six inches tall. Is in his early fifties and with his blonde hair extensions, looks like an old time rock and roll star. He kids about the time he was a fashion model and feels he has another need he hasn't fulfilled as of yet - being BATMAN. Yes we have a Psychiatrist that has a life sized Batman model standing in his living room. He has a Batman outfit at home and, since he has the funds for it, would purchase the real batmobile.
What is fun about the fashions he wears, the comments about rather dressing up women then undressing them, is the intention to make everyday fun filled and action packed. With crisis management he is a Godsend. We as a staff have laughed our way to hiccups during stressful days. He says the more stressful it is the more silly we should be.
Today Dr. J. brought in patent leather shoes that a coworker put on. They had 6 inch heals and zipped up to mid thigh. Watch my coworker walk around the office this way shifted my doldrums - to say the least.
A client stopped me once and referring to Dr. J, said "I thought Halloween had ended." "Not at this office." I smiled back.
Friday, January 29, 2010
Thursday, January 28, 2010
Therapuetic Bond
Without a connection with the client, no improvement will occur. Why? Because with a bonded relationship, miracles take place. There are a litany of articles and books written on the subject. It is important to know that even in everyday life if care isn't provided relationships of all types end.
In a crisis situation it is of the utmost importance for a clinician to open their heart to the person in distress. I've talked at length with my mother about this subject. We both feel that something inside of us naturally opens wide - a compassion - when somebody is in despair.
Today a young man entered the crisis center, obviously not wanting to be there. A long term drug abuser, who was angry with the world. I fought hard throughout the interview to find compassion for him but it wasn't coming. He had every right to feel angry. His family discarded him, he had lived on the streets well before age 18 and had a bad experience with counseling, rehab, and medication. I wanted to feel for him but my guard went up with his anger. My life long issue has been with anger, seeing far too much of it in my youth. Realizing underneath all the anger he displayed was a hurting individual.
I began to talk to the hurt part inside of him starting when he was a young child. At the time his father left and his mother remarried an abusive man. Like magic the session shifted. I found compassion for the sad and crying little boy who suddenly appeared in the seat in front of me. The lines on his face smoothed, he began to let go of compressed hurt that was underneath the hard layers he presented to the public.
After his Psychiatric interview he shook my hand, looked younger and happier. He told me he would never forget what we had talked about and my kindness.
Whatever it takes. Clinicians need to somehow find compassion within themselves for their clients. In doing so magic takes place.
In a crisis situation it is of the utmost importance for a clinician to open their heart to the person in distress. I've talked at length with my mother about this subject. We both feel that something inside of us naturally opens wide - a compassion - when somebody is in despair.
Today a young man entered the crisis center, obviously not wanting to be there. A long term drug abuser, who was angry with the world. I fought hard throughout the interview to find compassion for him but it wasn't coming. He had every right to feel angry. His family discarded him, he had lived on the streets well before age 18 and had a bad experience with counseling, rehab, and medication. I wanted to feel for him but my guard went up with his anger. My life long issue has been with anger, seeing far too much of it in my youth. Realizing underneath all the anger he displayed was a hurting individual.
I began to talk to the hurt part inside of him starting when he was a young child. At the time his father left and his mother remarried an abusive man. Like magic the session shifted. I found compassion for the sad and crying little boy who suddenly appeared in the seat in front of me. The lines on his face smoothed, he began to let go of compressed hurt that was underneath the hard layers he presented to the public.
After his Psychiatric interview he shook my hand, looked younger and happier. He told me he would never forget what we had talked about and my kindness.
Whatever it takes. Clinicians need to somehow find compassion within themselves for their clients. In doing so magic takes place.
Wednesday, January 27, 2010
Caring Co-worker
It is imperative to have a supportive team to work with in a crisis situation. Clients that are paranoid, angry, and at time homicidal can test your nerves - to say the least. If the staff is cohesive, supportive, and caring towards one another, you feel safe, more upbeat, and this internal atmosphere generally transmits back to the clients and makes them more calm. One would think that people in the mental health field would have a loving and caring attitude, ready to jump into difficult situations because they care about their fellow man. Well in an ideal world this would be true, but unfortunately our world is not ideal.
Take my coworker ____ for example. _____ is quirky, complains about the work, but when involved in a session is great with the client's to a point. Often after a session, _____ will complain the patient talked too much and didn't listen one bit.
The number one trait of a great counselor is being able to listen. How can we provide help if we don't listen to what a person says? I learned this from studying Carl Rogers - one of my all time favorite Psychologists. Carl perfected the art of simply listening. He stated: "People are just as wonderful as sunsets. I don't try to control a sunset, I just sit back and watch it in awe."
My coworker and I have been at odds in battling for a work station. With budget cuts industry wide, we have a few night time employees working during the day, having to close our night and weekend shifts. This has created more people and not enough computers to work on. Could you believe that this co-worker, this loving soul logged me off the computer in order for him to work at that station? Yep. Then the arguement ensued. "I was waiting for the station and when I returned to the room I was entitled to this very spot."
Yes this is a co-worker, a supposed team player, who has dedicated his life to helping others and supporting his fellow staff member. I thought I was here to deal with clients.
Peace. Out.
Take my coworker ____ for example. _____ is quirky, complains about the work, but when involved in a session is great with the client's to a point. Often after a session, _____ will complain the patient talked too much and didn't listen one bit.
The number one trait of a great counselor is being able to listen. How can we provide help if we don't listen to what a person says? I learned this from studying Carl Rogers - one of my all time favorite Psychologists. Carl perfected the art of simply listening. He stated: "People are just as wonderful as sunsets. I don't try to control a sunset, I just sit back and watch it in awe."
My coworker and I have been at odds in battling for a work station. With budget cuts industry wide, we have a few night time employees working during the day, having to close our night and weekend shifts. This has created more people and not enough computers to work on. Could you believe that this co-worker, this loving soul logged me off the computer in order for him to work at that station? Yep. Then the arguement ensued. "I was waiting for the station and when I returned to the room I was entitled to this very spot."
Yes this is a co-worker, a supposed team player, who has dedicated his life to helping others and supporting his fellow staff member. I thought I was here to deal with clients.
Peace. Out.
Tuesday, January 26, 2010
Scope of Practice
In the field of Psychology it is natural for a therapist to try to help everybody. We often feel if we could help out one person, the same principles could help another. In an emergency situation this could be disasterous!! It is important to stay within your expertise - in clinical terms called Scope of Practice
In the Mental Health Urgent Care, we see a vast spectrum of adults who suffer from mental illness. The degree of impairment is from catatonic to high functioning. Can deep interpersonal work be managed with those barely functioning? I am afraid not. It takes a working relationship, trust, and little "ah ha" moments of insight to solidify a good therapuetic relationship with clients. Can this be established with everybody? We are hopeful but this isn't practical.
Don't get me wrong. I have seen clinicians make tremendous connections with paranoid Schizophrenics in a homicidal fit. Can I do that? At times I have but that is the exception to the rule. Working with people at this level of distress on a daily basis would burn out the best clinician in a few weeks!
My training is on people that have good insight to themselves, can be a bit introspective, and are motivated on changing themselves for the better. When somebody doesn't fit that criteria they are now outside of my scope of practice.
A person came in for help today who had a lifelong impairment. Off her medication for a few weeks she was unstable, fighting with others and needed to stablize on medication. This person had a mild developmental delay (formerly referred to as mental retardation), had delusions in which she lived in a fantasy world, and a history of psychiatric hospitalizations. Can I as a therapist work my magic and bring the subconscious to the conscious? Since she had no real insight to herself this would be an impossiblity. Plus, her subconscious was already at the surface. Digging more into her mind may create more problems anyway. Therefore I knew to assess her for dangerousness, refer her to the staff Psychiatrist (who I will be talking more in depth about in the future), and make sure she had a support group that would monitor her compliance to taking her medication.
In the Mental Health Urgent Care, we see a vast spectrum of adults who suffer from mental illness. The degree of impairment is from catatonic to high functioning. Can deep interpersonal work be managed with those barely functioning? I am afraid not. It takes a working relationship, trust, and little "ah ha" moments of insight to solidify a good therapuetic relationship with clients. Can this be established with everybody? We are hopeful but this isn't practical.
Don't get me wrong. I have seen clinicians make tremendous connections with paranoid Schizophrenics in a homicidal fit. Can I do that? At times I have but that is the exception to the rule. Working with people at this level of distress on a daily basis would burn out the best clinician in a few weeks!
My training is on people that have good insight to themselves, can be a bit introspective, and are motivated on changing themselves for the better. When somebody doesn't fit that criteria they are now outside of my scope of practice.
A person came in for help today who had a lifelong impairment. Off her medication for a few weeks she was unstable, fighting with others and needed to stablize on medication. This person had a mild developmental delay (formerly referred to as mental retardation), had delusions in which she lived in a fantasy world, and a history of psychiatric hospitalizations. Can I as a therapist work my magic and bring the subconscious to the conscious? Since she had no real insight to herself this would be an impossiblity. Plus, her subconscious was already at the surface. Digging more into her mind may create more problems anyway. Therefore I knew to assess her for dangerousness, refer her to the staff Psychiatrist (who I will be talking more in depth about in the future), and make sure she had a support group that would monitor her compliance to taking her medication.
Monday, January 25, 2010
My Hands Are Tied
Working in an Urgent Care Mental Health facility for the past eight years has afforded me tremendous challenges, experiences, and inspiration. This blog is intended to share my field experience in hopes to improve myself, my skills, and my sensitivity to the people I treat on a daily basis.
Today a father brought in his adult son for treatment. The son wanted help with anger and his mood but was resistant to taking medication for it. In working at a facility who's focus is on medication management for whatever ails you, my hands were tied. I, by law, can not force medication on anybody. Well, that is unless a person becomes a danger to themselves, to others, or is disabled to the point they can no long manage themselves. Pertaining to the son, he was not dangerous or gravely disabled so the only other option for him would be undergoing months of therapy. Why months? Because at first walls are up, first between therapist and client, and next within ourselves. What percent of the population are willing, and or able to undergo this level of therapy? According to the county of Los Angeles with acute clients - the vast majority do not have the inner resources to deal with their issues so medication management has become the mainstay in mental health treatment.
Working in the E.R. it is essential to assess people the moment you meet them. Are they dangerous? Are they in a medical crisis needing a medical doctor's care? Are they under the influence of a substance? Do they have the resources to handle their situation? Do they qualify to receive services from our facility? If not what facility would better serve them? Five seconds later I smile at them and introduce myself.
I opted to briefly interview his father since the son had a paranoid stare - worrying if I was about to lock him up in our facility. The father validated my impression, he was in no state to undergo deep psychotherapy further tying my hands. I couldn't help him, our Psychiatrist couldn't help him, but the local Mental Health facility may be able to if, and only if the son agreed to take medication.
What does an individual need to do if they want help, but the only hope available is against their wishes? This son has slipped between the cracks in our mental health system. Unable to undergo psychotherapy due to impatience, angry outbursts, and immaturity; not wanting the medication we have seen stable thousands of people that enter our facility on a yearly basis; this particular person unfortunately is back to square one - in distress and wanting a positive change in his life.
Today a father brought in his adult son for treatment. The son wanted help with anger and his mood but was resistant to taking medication for it. In working at a facility who's focus is on medication management for whatever ails you, my hands were tied. I, by law, can not force medication on anybody. Well, that is unless a person becomes a danger to themselves, to others, or is disabled to the point they can no long manage themselves. Pertaining to the son, he was not dangerous or gravely disabled so the only other option for him would be undergoing months of therapy. Why months? Because at first walls are up, first between therapist and client, and next within ourselves. What percent of the population are willing, and or able to undergo this level of therapy? According to the county of Los Angeles with acute clients - the vast majority do not have the inner resources to deal with their issues so medication management has become the mainstay in mental health treatment.
Working in the E.R. it is essential to assess people the moment you meet them. Are they dangerous? Are they in a medical crisis needing a medical doctor's care? Are they under the influence of a substance? Do they have the resources to handle their situation? Do they qualify to receive services from our facility? If not what facility would better serve them? Five seconds later I smile at them and introduce myself.
I opted to briefly interview his father since the son had a paranoid stare - worrying if I was about to lock him up in our facility. The father validated my impression, he was in no state to undergo deep psychotherapy further tying my hands. I couldn't help him, our Psychiatrist couldn't help him, but the local Mental Health facility may be able to if, and only if the son agreed to take medication.
What does an individual need to do if they want help, but the only hope available is against their wishes? This son has slipped between the cracks in our mental health system. Unable to undergo psychotherapy due to impatience, angry outbursts, and immaturity; not wanting the medication we have seen stable thousands of people that enter our facility on a yearly basis; this particular person unfortunately is back to square one - in distress and wanting a positive change in his life.
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