with my arm around the moon...


North Carolina,
June 28
Buddhist, seeking, awakening... Currently spending much of my time swinging wildly between hope and fear.


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JUNE 21, 2011 12:38PM

Mid-day musings of a worker bee

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I came back here to write for the first time in 6 mos. and discovered that my last post was on unexplainable sadness. Hm-m-m-m...

Today seemed a day when I wanted to write about it, in a place where other humans might see it and understand. I've had tears in my eyes most of the morning (an unbecoming amount of tears, I'm thinking. Tearing up with my clients when they're hurting deeply is just a part of me. But today, the tears have endured even after they've left my office).

After 6 mos. of many layoffs in the mental health company where I work, another large salary cut, losing 2 out of our 4 therapists, then being faced with a barrage of clients from the ones who left PLUS new clients coming every week, I feel less competent than I ever have before in my work. I still want to do a good job, still want to research every condition the people have that walk in my door (Alzheimer's, Obsessive-Compulsive Disorder, Developmental Disabilities) so that I can work with them well. (I'm treating people with DD for the first time, after yet another therapist, who was here part-time, was pulled away to work at another site). We've also had increased fine-tooth-comb scrutiny of all our paperwork, looking at our casenotes to see if the interventions we say we did [note the mistrust inherent in that statement] warrant the amount of time we say we spent. I've been called down because my client's treatment plan goals are often not measurable (how do you measure tears? How do you measure moments of hope vs. moments of hopelessness?). I've always been one of the ones that thought that was a ridiculous requirement. Often all they want is a number added to the goal. Here's an example: "Suzy Q will decrease her stress level by not dwelling on past regrets, 7 out of 10 times she is reminded of the past, over the course of the next 12 weeks".  I didn't write that one, but these days, I'm writing ones that feel no less arbitrary, and have little to do with why people say they're here. The goals they have for themselves often don't fit into the required framework.

In addition, the forms we must fill out to document that people actually NEED the higher-level services we are wanting to refer them to, are increasing. They take me a long time to write. Every month or so there's a new one, so that if the company is audited, the auditors can go right to the page in the chart or the intake where the required information can be found. It seems that most of what we do is about preventing paybacks of the money the company receives if we are audited. Almost never do I hear anything about the clinical aspects of our jobs, and then, it feels hollow. Lip-service---that phrase never rang so true about any endeavor I've ever been a part of.

My boyfriend/housemate told me a couple weeks ago that I can quit my job, and we'll make it somehow til I can find another job, or cobble together a living with part-time work. He said that when we come back from our 3-day vacation next week, he would like me to give my one month notice. That's the standard length of time clinicians usually give. But if I did that, I'd be leaving a number of clients who lost a therapist 3 mos. ago, a number of brand-new clients I've just started with, and one lone therapist to grapple with it all. (They did have to bring in a person part-time to take up the slack brought about by the lay-offs and exits, so she'll be here for some of it. Thankfully, both of those 2 are young and strong, new in the field). He says that he can't bear me coming home exhausted so late at night (7, 8, or later, after leaving at 8:30 a.m.). He can't bear to see me cry because I'm so tired or discouraged about my job. Our relationship is suffering. Joy? Play? There are rare moments of that, and I am (we are both) so thankful for them! I am also thankful for the incredibly talented and dedicated colleagues I have here. And the clients? Often heroic, dealing with circumstances which would turn me into a puddle.

Two weeks ago, we found out that a former colleague had died. She was a few years younger than me. The circumstances were not in the paper, and I've not been able to find any information about how she died. I remember she was stressed a lot when she was here, and hoped the job she was going to would be less so for her. I do hope the last months of her life were easier on her. When a higher-up spoke of her death, it was said, "She would come in at 3 a.m. to do her casenotes". Man, that's a heck of an epitaph.

Writing this has dried my tears. It's clear to me that I will be soldiering on, at least for a while. I've applied for 2 other jobs, and heard nothing. I will stay in harness for a bit, doing the work I love, with people that mean a lot to me. I will hope for an exit as soon as is prudent. I'd rather not go, but the system is grinding down many of us (both clients and workers), and I want some joy and health in the time I have left on the planet. So, as a sign on my desk says, "I will do my best; that's all I can do".  In a day and a half, I'll be off for four days, and will squeeze in as much time on the beach as I can. Looking at the sea, luxuriating in the wind, wriggling into the sand with my whole body, looking up at the sky, and feeling the beauty of being alive, and the wonder of being with my love. I will not think of coming back to work until the drive here next Monday morning!!

To anyone who got this far---thanks for listening!

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I think it's part of our growing cult of science that we want to quantify everything in some measurable way. We want a pill and a formula to fix everything. Just another false god.

Glad you returned to writing to get this out of your system. One thing to consider is that if you become a mental wreck yourself you may not be able to help your clients regardless.
Rose...reading this, I found hope in your boyfriend's request...I think the universe through him is sending you a huge message...I'm so happy to see you again...xox
For me as a teacher it was frustrating trying to quantify progress in human intelligence. I can only imagine what it is like trying to quantify human emotions. Thanks for the hard work you do for your clients and here's hoping something better and more lucrative will come your way.
Yes, Harry, the "measurable" goals thing is probably an attempt to show that what we do is scientific (and therefore worthwhile, and therefore deserves to be funded by Medicaid, etc). I feel as though burnout is here for me, and I know my work with clients is far less effective than it would be if I were healthier. They, and I, deserve better than this.

Robin, I was touched by my boyfriend's request, and burst into tears...which I think were also about hope. Sometime soon, I hope to take him up on his offer. And I'm very happy to be back here---thank you!!

Miguela, I think it takes true scientists, with solid training in research, to have a prayer of quantifying human change in any meaningful/useful way. In the trenches, where therapists and teachers are, it seems like folly to try. Thank you for wishing me well!
We need a follow up, Roseincarolina. What did you decide? Tell us please.
We need a follow up, Roseincarolina. What did you decide? Tell us please.
It's kind of sad when soldiering on seems the best we can do, but I admire your ability to find and exult in those small moments of joy. I agree with your distaste for quantification, for making things measurable so we can be held accountable, as if someone, like you, dedicated to their work doesn't hold herself accountable, every day, with every client. I run across this in education, too, especially as an Engish teacher. Some things are quantifiable, but, somehow, it seems to me, the really important stuff that happens in a classroom, or in a student's mind or imagination, can't be reduced to a number--heck, that important something may not even happen until years down the road, or so I judge from emails that I get from former students. I hope you'll let us know how things work out for you.