Supervision

I have been questioning higher ups in administration. I think it is the classic worker versus authority issue so many have. Alright, I have. Years ago I was corporate treasurer for a production company in Hollywood. I realized at that point there were two ways to motivate my workers, treat them with kindness, as if they were children needing molding, or motivate them with discipline. Obviously I am not very good at being a bad parent so I learned praise, having them point out what needed improvements, and spent times on coming up with a plan of action together. Twenty years later many of my workers still gather for Karaoke singing and celebratory parties to commemorate that great times!

Having this supervisory background, recent events at my placement have felt demeaning. It is as if the police is write something down on the permanent record first, then discuss it later. Which to yours truly doesn't really fly.

I remember twenty five years ago when I was cleaning swimming pools. Yes, you should have seen me in my shorts, my tan, and my Greek Godlike body. You know what, this really hasn't changed. Anyway, at this time I learned that pools that I couldn't stand eventually were lost - they were usually leafy, moldy, and having insufficient equipment in which the owners refused to replace. This may be happening at my current placement.

I have had a good run at this job. For eight long years I have had numerous supervisors, some good, some poor. One thing dominates - I have never ever had a single note written in my personell file. Pretty interesting, wouldn't you think. In seeing roughly eight hundred people a year for eight years and not a single write up, it shows the direction this firm has gone into hiring a disciplinarian. And now the pool has suddenly become moldy, filled with leaves, and the equipment is running poor. As a result I am frustrated, but it doesn't hold a candle to many of my coworkers sentiments.

Too bad. What we do for Los Angeles county and beyond is miraculous! Where do people go to when they are in a crisis and they have no insurance or Medical? To us is where they go! We have recently seen our 16,000th new person! That is a lot of crisis.

I have taken a cut in pay to work at this firm for a reason. I felt it was noble work. In fact I am sure of this fact. Now with a family I may change directions and move to the money grabbing game instead. Eight long, very fulfilling years that are now fading into the background due to a faulty filtration system.

When my last supervisor quit, due to acute anxiety attacks, I pondered taking the position. The salary increase was enticing, however I love to work in the trenches. Still I sat down with the regional manager, threw around some ideas I had about the position, but didn't pursue it at all. My coworkers sure wanted me at the helm and now I can see why.

So I slowly see the crossroads ahead of me. Let's see which path I decide to take.

Oookaaayyy

Interesting turn of events - to say the least. When I get angry about the job, something is definitely wrong. I never ever get this way because I love my work mates and appreciate the amazing clients who have suffered incredible ailments and have overcome so much trauma in their lives. Unfortunately I have had a human week. A week that has been filled with anger, reflection, and regrets. Regrets? Well as a doctor I could be working at a better paying job for sure, but I know all to well that in the crisis arena I shine.

I came into the building today and was immediately met by our office manager. They were throwing a celebration for me and a few other people in the building for our ideas of beautifying the facility. My idea of a waterfall in the front lobby got the top mention and I was being honored. Not making a note of this, I showed up late to my own celebration! Well better late than never and I showed up to scattered applause as I took the award and said a few words.

Then the other great news: I am getting a raise! This didn't come from my boss - but from his! I am definitely having a bipolar week. The ups and downs are unreal. Maybe I need some Abilify, though I do like the ups!

We had to close our door today at 11:00am - a first. We had already admitted eighteen people and the doctor wasn't capable of seeing any more. This is happening with more regularity. Unfortunately there is a down side to life and I get to see it daily. People get abused, their loved ones die, and many have never been treated.

We as a staff talk about a lot of subjects in a given day. It usually is driven by a comment or a name. One patient I saw today was Jesus. I actually counseled Jesus! Now I remember seeing Jesus when I lived so many years ago in a haunted house so talk about seeing a being of pure white light spread like wildfire around our office. It seems as if I wasn't the only one having a close encounter with the paranormal. Let's face it we are energetic beings. Some of us can let our light shine right through. You see these happy beings at sporting events when fans and players are euphoric, you see it with musicians, you see it with proud parents, and I am sure you too have had joyful moments. With the clients that come to the crisis room, they are far from the light.

How can we wake people up that are stuck in the dark? That is the key to therapy. We all have the positive wired inside of us. Asians are well aware of Yin / Yang. Though while stuck in a rut and angry as I have been in recent days, it can be a challenge to release the attachment to being right, getting revenge, and moving forward. But, it can be done and quickly.

A quick shift workshop is in order. It would take hours to type about it and still you may not get the experience. Stay tuned, this can be of great benefit to everyone.

May you all have great mental health.

What The F....

Today was one heck of a day! It started out with my best friend telling me his traffic court appeal was turned down. Just because he pulled around a driver, rubber necking to see a policeman give somebody a ticket, he was pulled over for driving too fast. My friend brought in charts and the Judge laughed at them. $240 dollars later my friend left rejected.

Then it was my turn. In not stopping a person from getting out of the building yesterday I was punished. Not following protocols in mental health has led to a domino effect - which was somewhat tragic.

Of course nobody died, but the way things got handled felt like a crime - well at least in my mind. I of course never make mistakes, and I was mistaken to think that the well groomed couple happily leaving the facility needed to be detained.

At the point of the people leaving I had a few choices - 1) Ignore the voice in my head telling me I might have screwed up and tell the staff. 2) Play stupid and ignore the situation where eventually the staff would wonder what happened to the individual. Not aware of a number 3, I opted to contact staff and let the chips fall where they may. Which led to some punitive action towards yours truly.

What happened? Is it more important to be punitive than corrective? This act is getting really old. But as I was told, that 1% time when our guard is down, something serious might happen. What a f'd up way to look at life - but we are in a litigious society and lawyers are on the prowl waiting to pounce on us good doers. But the story get's deeper.

Because the one clinician had to get involved in returning the person to the facility they were contacted and on their own accord returned with their partner confused, angry, and upset. In doing so accusations were flying, a formal complaint towards my coworker was written, and an investigation of the case is now underway. What the f...

I blame myself. So what if I had a few hours sleep, had a dental appt earlier that morning and was ready to pass out upon my arrival to the job. So what if interns have to stay awake for twenty hours in their residency. I learned that when I am not rested simple mistakes can cause huge ripples.

How can I tell my coworker how sorry I am? Another coworker was investigated by patients rights because I told an irate client their name upon leaving. I am still trying to brown nose my way around that one.

I thought I would enter this industry to be of help. Now I feel human, flawed, and upset.

Hopefully the next day will be better. I know what I do 99% of he time. Being human is a new experience - humbling I would admit.

WOW!

Have you ever had one of those days? Well today was that day for me. What do I mean by one of those days? Well, all I can say is I am so glad today is coming to an end!

It started out as a typical Scott day, you know, wake up on Dad's couch after working on tiling his house all weekend and feeling dead to the world. Then rushing to the dentist to get some stiches out. You know the typical morning ritual. Finding out the my friend the dentist has a doggy door he is throwing out which caused me to rush over to his house a few miles away, picking it up, and dropping it off to my dad's. You know pretty typical in my world. There is a need, something comes up in conversation, and then something manifest's itself for the good of me or others - sometimes both.

But when work began it was not that ordinary - no not one bit! The office had a wall cut out and our room was expanded to twice it's size! More room meant more mayhem! There were new staff members, rushing this way and that and then the bomb was dropped - somebody was placed on a hold and unknowingly yours truly let them out of the building. OPPS.

So the scramble began, searching this person down and contacting the police. Yes - that's right. If somebody has a hold written on them and they get out the police need to provide assistance. Luckily the person was called on the phone and reluctantly came back to our facility. What luck!

But this is where the saga gets interesting. The person was sent back from the hospital and accusations about a staff member were described. Not good. A scandal perhaps? Is the news going to show up here? Were false accusations made? Even though the person was psychotic, it is important to hear them out and we did. Therefore the hold was relinquished - a rare thing indeed. Obviously the meetings and the Pow Wows about this are about to begin and I am curious where this merry go round is going to end.

We've, in our eight years have had a few scandals here. Some have gotten ugly, some have cost our company a pretty penny. You would think that those in mental health have got their shit together, and I hope the person in question does because I love them very much. Only time will tell however.

What started out typical was everything but in the end. Lots of questions being asked, lots of holding one's breath, lots of impatiently waiting for... well let's just see.

May you all have enhanced mental health.

Performance Review

Well it was that time again. The annual performance review is always a favorite time for me. Of course I am sarcastic about this. I literally hate being evaluated by a higher up who is never in the client sessions with me, listens to the heresay of the office, and basis their opinions on some kind of secret guide or appearences in the hallway.

I had a past supervisor who based their review on keeping salaries to their minimum. Therefore every rating was on the low side. Last year, not having a boss, the regional manager of the company sat down with me and gave me high praise! I was shocked! In interacting with this person, we had from day one not only got along great, but also managed to make each other laugh constantly. So I knew that they were going to give me high marks. On this day, meeting with the new supervisor had me a little aprehensive.

At work I try to keep things light, laugh around with my fellow workers and push the edge of harrassment - knowing my limits of course. Did my antics disgust a few of the more prudish workmates? Did my easy going attitude show I wasn't professional enough? Especially with individuals in a crisis? To many folks that don't see my skills behind the closed door sessions they may take my blue jean attire, and my lengthy sessions as me trying to buddy up with people. Obviously this couldn't be further from the truth. I dress this way for a reason - to kind of blend in with the less fortunate population I serve.

So there I was seated with my supervisor, waiting for the hammer to fall. I see so many people in a year, one or two were bound to make some kind of complaint I thought. Then it started the page by page critique. What impressed me the most was their being right on the mark! I was shocked. I heard about me - the professional me, the communicating me, the helpful me, the social me, the compassionate me, the creative me. Did my supervisor have a hidden camera?

After the ups and downs of working in a difficult setting where it is literally live or die situations on a daily basis I was acknowledged. The mark of a great supervisor is letting their workers know their strengths and work on their weaknesses. And trust me, not one mention was made on my deficits which was a first. Trust me there are many and I am somebody who does appreciate the criticism. Obviously, if you knew anything about my personal life.

So the reviews are great, a raise in salary has been promised, and maybe I can afford to keep the vacation place in the desert!

May you all have great mental health.

Hugs

Connections with clients are the name of the game in psychology. Without a positive interaction with the person seeking your counsel - why bother? Why bother with the industry if you are there only for the paycheck and trust me that isn't too great at my level. You would think that crisis counseling would afford a great level of pay because we literally are saving lives, but that just isn't the case.

How often do we actually connect not only at an intellectual level with somebody, but through the heart, and even to the soul? Crazy question? Not really.

Let's face it, we are not robots. We are emotional beings whether we admit it or not. And trust me, we interact with our emotions more than we care to admit. If we are in a fowl mood - it's emotions. When we want to blame people for making us feel angry, depressed, or anxious - it's our emotions. When we feel unworthy in relationships, at work, or in our creative pursuits - it's our emotions that are leading the way!

How do we shift our emotions? When anger takes hold it can be a difficult beast to release. You first want to ask yourself if you want to let go of your attachment to being right. In the Win / Lose, we all lose - even the winner. In focusing on living life with a loving heart - no matter what the circumstance - God works through you.

I get tested especially - though I am sure there are those who get tested more. I put myself in the front lines in which people are so fed up with their emotional state, the governmental system which has failed them, and all they want to do is release their frustration if they feel "disrespected" by yet another person. Eight plus hours of this at the jobsite can drain you - trust me. Then what keeps me going? The heart to heart connections that can be easily achieved if you are willing to let down your guard and love the person who is seated in front of you. Who cares if they are a different color than you. So what if they have two heads. Gay, straight, have Aids, are Lepars - bottom line everybody is deserving of love.

I had a few great sessions today. Well in all actuality they all went pretty well. Even when I think the client and I aren't on the same page I at least make the effort and try to show them I care about their fate. In just the effort alone I get rewarded. Often people open up and share the sensitive information they have been hiding inside for years! That is my real reward. In fact after doing this today I got a huge hug! Who would have thought the angry person I brought into the facility would leave teary eyed and happy?

If I don't receive the huge bucks, hey, a great hug is appreciated - along with the food the drug reps bring in from time to time.

May you all have great mental health.

Counseling While In Pain

A true mark of an athlete is playing with pain. Well, my athletic days are long gone, though time to time I do have to work with pain. Pain can be a good thing. At least that is what Dr. Bernie Segal said at my graduation from The University of Santa Monica so many years ago. According to Dr. Segal, pain is what motivates us to change and be better. In fact, he wished pain upon us all. Thanks a lot dude! Your wish has come true numerous times and the last horrah was when my tooth was extracted on monday. So a day later, I staggered into work thinking that everybody can see the knife still hanging out from the place my wisdom tooth once occupied. And of course Dr. Segal was right - I had a string of incredible sessions.

Interviewing clients when I am not one hundred percent makes me more empathic. Well aware of my own suffering - which is usually momentary - I interview people who have to tolerate not only physical difficulties, but emotional ones on a daily basis. Some have to endure psychosis! For years!

I am reminded of one client I interviewed when I first started working at the Urgent Care almost eight years ago. This person told me they were never treated, was in their mid forties, and for well over twenty years had been tormented by voices and visions at bed time. At times this person actually felt people grabbing her! It made me wonder if schizophrenia is simply a sensitivity to the Beyond? Who really knows? Maybe they can see through the thin vale between our reality and the paranormal? Still for twenty years being tormented, it must have been something way out of their paranormal existence to bring them into seeing me!

Pain is a part of everyday life unfortunately - or fortunately depending on Dr. Segal's outlook. It is the amount of pain that is the real issue. In my youth, my friends and I had a saying - "A little pain never hurt anybody." Yuck yuck. It was probably something drummed into our heads while playing little league baseball. Trust me, now that is a sport filled with pain. I used to get hit by pitches, have balls bank off of my shins, sprain fingers, slice my knees up sliding. In fact I still have raspberry scars on my hips from sliding in Semi-Pro ball. Me of all people, who hates pain sure choose the wrong sport to pursue. Thank God I didn't fall in love with Football like my best friend Mike. He has now had seven knee surgeries because of that foolishness.

Pain is not going to go away. How we confront it shows our character. Some fear it and some embrace it. I tend to do both, given the circumstance. One thing for sure. I am going to floss and take plenty of vitamins from now on to avoid going through that pain again!

SEE YA!!!

It's friday. Thank you God. Yes I had one day I didn't come in due to cabinet hell at home. Yes one day this week I only saw one client. However, in the last two days I saw EVERYONE!!! Oh my was it busy! I saw so many unique cases that stretched my clinical skills to their limit. I loved it on one hand and hated it on the other. Yes I love helping people in need, but can it be one at a time and at a leisurely pace.

Pregnant women, suicidal people, homicidal people, psychotic people, people that didn't have a friggin clue. And now the weekend is approaching quickly. I have one more client to present and am leaving in the next forty five minutes. So I wanted to chide in before heading back out to my desert oasis.

With all the kidding aside. Or should I write complaining. I had the pleasure of teaching a new intern the ins and outs of our facility, how to interview clients, and how to attack the massive amount of unneeded paperwork that our facility demands. Of course the paperwork is needed. "If it wasn't documented, it didn't happen" is our slogan. Do you realize I have had nightmares about not getting in a chart in the proper allotted time period? I joked with the intern today about spending more times on the paperwork then the one to one client sessions. In all actuality it is true.

One thing that perked me up today was the feedback from the intern. They loved my presence with the clients, how I honored them and gave them ample time to simply speak and search their minds for answers. It felt good to be noticed. It had been a long time since a neutral observor was in one of my sessions and I let down my guard and simply was myself. It was with a very difficult client who was placed on a hold. Even in these sessions compassion can be shown. This is what I am leaving behind. Not just that but the madness at home.

Madness? When your home is all torn apart and the cabinet makers make your cabinets too thin it can grate on your nerves. Trying living for weeks without a working sink. In fact we don't even have one attached! Everything is in boxes - but thank God I have a vacation home to go to. My excuse for going there - I needed to transport some shelving there.

Got to run. I have to make my last report. SEE YA~!

Tick Tock Tick Tock

What a rare day. Absolutely no clients for me yet and I have three hours to go. Life has been in hurry up mode for as long as I can remember. Today it is suddenly on STOP! So this is what it is like to drop your shoulders, breath, and have time to simply think. I like this. It's as if I am in the desert and just taking in the beauty of life. Does life really go on at this pace? Is there relaxation, short conversations with coworkers, then time to kick back and type on one's blog? Today there sure is.

Because we are strapped for space and have too many workers and not enough computer terminals, I rushed out of the office and found an adjacent office that was vacant in which I could use. For hours I have watched me in others as they race around, accomdate people, rush paper work in before its deadline, and gave the automatic smile that works so well in mental health circles. You know what I am typing about, the head slighly tilted, the grin big and genuine, and two steps later when out of sight the scowl returns. Well at least we don't greet people scowling.

In the larger facility I work in is a long term, lock down Hospital for those with extreme mental illness. Most look over medicated, some look like characters from a haunted movie. Unfortunately this is real life and many of these folks have been committed here for ten to fifteen years!

When I first started working here I feared these people. I often heard stories of them randomly striking people for no good reason. I need to walk past them in the hallway from time to time to bring clients some food from our cafeteria. With hands holding a tray I am vulnerable to the Thorizine shuffling gang.

Years ago my younger sister worked in mental health with this particular population. For a man it would be slightly easier, for a woman the is small and petite some of these folks are threatening. In the long run my sister got abused and left the industry for good.

Abuse towards staff happens with some regularity. It depends the temperature, since the heat of the summer tends to bring it on, it depends on adherence to medication, in fact there are a lot of factors that will breed violence. The most important aspect is having a cohesive staff that will see the signs, communicate clearly, and takes swift action.

Tick tock, there goes a coworker home. How great is it to have some thinking and reflecting time.

May you all have great mental health - I could use a few days of this.

Desperately Seeking Dr. Scott

Years ago I watched the movie Desperately Seeking Susan. I think it was Madonna's first acting role. In the movie this guy is detained from his normal pattern, trying to pursue some woman, and can not get back home. Well that is at least what I remember. Well today this happened in my life.

At home we are undergoing kitchen renovations and our new cabinets were manufactured too thin. I mean we can't even put plates into our shelves because they are literally five inches thinner than what we original had and asked for. This is where my saga of the day began.

In contacting the company who installed them , they agreed to send out a representative to meet with us. We were assured the person would be there around noon. Well I don't know about you, but when I keep a commitment, this is "my word". I make it a priority to be there and if I can't I will call - like the true professional I am. Time in the psychology world is extremely important - especially if a client is going through a crisis - which is normally the case for me. Well noon came, one o'clock came, two came and suddenly I was in crunch time for work. At this time we amp up and it is important to be at work and involved. Still no representative.

Now if I had a clone, I could take care of both matters. Dr. Scott could see clients and at the same time domestic Scott could point out why twelves inch deep shelves, which are actually ten and a half inches, don't accommodate twelve inch plates. Torn I waited till three o'clock and in frustration took off towards work. This was an interesting decision in making clients more important than pleasing me. But that is how I can be and often times am. Today I gave the cabinet company five hours of my time and couldn't wait any longer. That's what I give to me, that's what I give to you. I try to meet people in the middle.

Trust me, I was sick of hassling the representative, thought he wasn't going to come, so I took off. Then in calling work from the road learned that a coworker was called in to take the shift of a morning person who got sick and was there to cover my shift as well. A REPRIEVE! God stepped in!

When I turned around and headed home I was shocked to find out the representative called and was there fifteen minutes after I returned home! Better late than never!

I hate when I am out of my routine. I know it is a part of life to adjust to problems, to adjust to changes in mood, to move forward in the face of adversity, and today was a test of this for me. But why did I get so angry and upset?

It shows me where I am at internally, when I get angry it shows me that something underneath needs addressing. Something inside is definitely out of balance but what? Is it physical? Yep, I have been working hard of not only busting out a kitchen and working on my place from sun up to midnight. Is it mental? Yes, I have been more negative in my thinking than positive. (Hey let's face it, I am human too). Is it emotional? Absolutely, mother's day was more of a priority in fixing my place and moving old cabinets to the desert home than driving down to San Diego to be with mom. And Spiritually I had been on vacation from God for a while. Thank God a friend emailed a link to a choir to me today. This sure plugged me back in.

As you can see, I look at all issues holistically. Tending to all the levels gives us all the best odds for enhanced mental health.

As for now, the representative came, understood our dilemma and promised to make it right. I wonder how many thousands of dollars is this going to cost.

May you all have great mental health

Seizure Disorder with a Mental Illness

When the brain has hiccups (seizures) it places mental health workers in kind of a bind. Psychiatric medication can exacerbate a seizure disorders causing seizures to take place if a person is not on medication to stablize their condition. What is amazing to us is people often forego their seizure medication for years and only want to treat their psychiatric symptoms.

A Seizure disorder is a brain ailment. Sometimes it is from heredity, sometimes it is from a head injury, and sometimes it is from substance use. Why clients argue vehimently about being sent away from our facility to take care of their seizure disorder is baffling.

Have you ever had a seizure or seen somebody having one? It isn't a very pleasant thing. Each time the brain has a seizure it causes brain damage. Fast forward to being elderly, Dimentia is a real concern for those who have had brain ailments. Wouldn't you want to protect your brain? It seems obvious to most. However those with a mental illness will complain and even throw fits if they don't get the elixer that fixes all their problems. And in all actuality we prepare the scripts, keep them in the client chart, and in as soon as a day later - after visiting a medical doctor the client can waltz in and out of here with their psychiatric prescriptions.

Somebody came in today who had been off of their medication for almost a year, and when we found out they had a seizure disorder we sent them away - as usual. The reaction from them was amazing! It was as if they wanted to argue their way into a grand mal seizure!

I had a client with a seizure disorder that was relentless. When the person was an infant the disorder started. As a teen they developed a learning disability, as an adult the seizures became so debilitating that eventually had to be solved with radical brain surgery. Why risk this? Why argue with the professionals that have experience with this?

May you all have great mental health.

Delusions

Today must have been the annual delusional day. Almost every client had a delusional disorder. People believing they were a different person, another believing the family was plotting against them, another was so paranoid it was important to just keep talking, remembering names and dates so I couldn't get in a single word. Now I am probably the worlds most patient guy but after a while even I was getting irritated.

On one session a coworker was brought in to translate. I was giving him side comments because he was a mental health trainee. "This is a text book example of delusions of persectution". "See how her story is her organizing principle". In this case I became more of a teacher than a clinician - but what can I do? This is strictly a medication management issue and from this point on it was my duty to convince somebody who believed the medication was another ploy the family was using to control them.

As I tried to get the client out of their story for the fifth time, they suddenly stopped in mid sentence and looked at me with a smile saying - "I trust you." Wow!!! Where did that come from I exclaimed to my coworker.

Mental illness at this extreme is facinating. When extreme I marvel at what an individual must endure day in and day out. It would be a hellish existence to constantly feel the Government was spying on you or the T.V. was giving you secret messages. But this is their normal. Without the voices they would be out of their element.

I remember watching a show last year about a married couple, up in their years, that were both deaf. A new procedure was developed that promised both of them hearing. At first they were excited, but the family was sceptical. They would be experiencing something for the very first time that they may not be prepared for was the consensus. Well in the long run the family was right. Having hearing was a difficult transition - more for the wife than the husband who seemed to struggle at first, and then go with it. The wife was overwhelmed with this new sense, similiar to patients of mine who have stablized and decide to go off their meds, and abandon their own self work. Why? Because the old habits are so ingrained in their way of being that it is too much of a hassle for them to take the effort in changing for the better. Hey, let's face it - this is extremely normal. I do it. I promise myself to cut down on sweets, eat healthier and excercise more often. What do I do? I come home, scoop out some ice cream, sit on the couch and watch television. Oops. Even though I feel better when I am active and eating healthier, chocholate chip ice cream and American Idol will always entice me.

May you all have great mental health.

Trainee

We have been training a lot of new workers lately. Some are interns and get a crash course here about real mental illness in action. Some are trained professionals looking for extra work to pay the bills. Still others are there for whatever reason - and we learn a ton of them. Today was a real blessing, having somebody seemingly level headed who withstood all the jabs and puns of the staff while handling a busy work day where clients needed to be sent away because we were so busy.

I could imagine walking into our office and seeing a flamboyant Doctor who dresses up every day as if he were attending a costume party. Yours truly with hair flying everywhere wearing my signature Mickey Mouse shirt. And other staff of all orgins from China to Iran to Korea to the deep South, to the Phillipines, etc., etc. It's like we have our own united nations!

I think this is awesome! I love learning about different cultures, customs, and languages. I can botch pretty much any language on the planet - with pride.

So today was the starting day of a new MFT intern who was trying to gain hours and experience towards her license. When the jokes started flying she held her own and tossed in a few jabs herself. This is the joy of working here. We as a staff have to let of steam and we do so while grazing the fine line between sexual harrasment and comedy. Oh, we know the limit line and never ever cross it. Trust me starting a statment and using silence is a real hoot - and we do this professionally! We also can morph a person's last name into something almost suggestive, but we stop just short of the limit line.

I wonder what the people in the waiting room must think when we all break into spontaneous laughter. I wonder how those who are psychotic must feel. "Are they laughing at me?" "Are they ploting against me?"

We have a few ongoing jokes that are repeated every week. Even if we don't repeat them, someone will eventually ask if we did. Of course with the new person we had to tell the darn Jose joke.

A woman friend of mine told me a joke about a man who had two members. His girlfriend was astonishe when she saw this. The man told her, yes he had two and he call the first one Jose, and he named the second "Hose B". Trust me, this joke has had so much mileage that we laugh at the mere mentioning of Jose. The Doctor is trying to make up a new joke for Jorge - but we've all tried to squander it.

So now you all know the inner workings of a staff that puts itself on the front line day in and out. If it wasn't for our wackiness, we too would be interviewing for a new job.

May you all have good mental health.

Realization

From time to time my brain clicks together and I get a big ah ha moment. It happened today while I was waiting for of all things a haircut. Years ago I had a client with multiple personalities freak out and run out into an adjacent neighborhood. What made me think of this person today was an unknown - probably because rushing after him still impacts me today. I searched street after street and found him hiding behind a car. On one hand it was very humorous, as if he was playing in an adult hide and seek game. On the other hand he looked petrified as if he was in terror for his life!

I rubbed my hair, as if saying goodbye to a familiar friend. Why on Earth would he do this? And then it hit me - this was his defense mechanism. When threatened our mind goes on the blink if our resources don't match the level of stress. This client was detained from doing his ritual of spending money - a source of soothing himself was gone and he reacted as a child would, running away and hiding.

When I walked up to him - a client I had a three month relationship with, he didn't recognize me. My client wasn't even there!!! This is mental illness at it's worst. Where was my client? Where was the person that told me the unmentionables done to them, told me I was the only one who ever cared, and wanted to face the demons that tormented on a daily basis their existence and wipe them out of their life forever!! So I reminded them of this (as delineated in my Doctor Dissertation). I reminded the client of our relationship, their life, how wonderful they were, and slowly the person looked up to me and cried. What can you do with somebody who's mind shuts down when under stress. It is as if their mind needs to be rebuilt and slowly given natural stressors in slow, manageable doses. Will their mind ever heal? This client went pretty far in their recovery process and was actually able to not only have a relationship for the first time, but move in with the person as well - talk about stress.

The realization today was in the disociative phenomenon in which the mind blanks out and another aspect within simply takes over. This particular client was aware of nine distinct personalities, which we dealt with extensively.

Therefore, for clinicians, it is extremely important to go slowly with clients, and monitor their reactions to the material that is surfacing for them. If it is too demanding - back off. Help them regain their center and acknowledge them for the ability to do so. It is not for us to heal large chunks of their ailment at one time. Therapy is a process that needs to progress at the client's pace.

Who thought waiting for a haircut could help me deepen my understanding of the defense mechanisms of the brain?

Good mental health to you and yours.

Peripherals

Today I really became aware of all the little things I do in a work day. Oh yeah I see my four to five clients, interact with the psychiatrist and will contact mental health providers for additional information. That is a given. However that is just the beginning of the job.

On a typical day, I get called to the front waiting room, will interview somebody to see if they are appropriate for our service. If not I will give them referrals and send them away. Sometimes I have to play peace maker if somebody is too violent or paranoid to enter our facility. Other times, if we are too busy I need to send people away which has insensed them into being violent.

Today a person came back to our facility after being sent away for a medical clearence - many times we need to see if someone is using substances, pregnant, or needing to get back on their antiseizure medication. When they return we need to search down their chart, look through it, find their medication script, or track down the psychiatrist and make him fill out one. Often their charts are located in another building in which we have to walk through a group of psychiatric clients held for life and looking for an excuse to lash out at somebody.

Now the phones are another issue. Often the calls are from pharmacies that need the doctor to change medication because the insurance doesn't cover it. Once again we have to search for the chart and search for the doctor and call the pharmacy back.

THe worst is placing clients on a hold. At this time we have to make a million calls, fill out more forms, deal with an ambulance who have to transport people in a gurney - bolted down - which often triggers them to violence.

If you are good at boxing, crisis work is a perfect match for you.

I laugh about all this because I thought I went into this field to help people. Little did I know it was helping people find their chart so I can scribble into it.