The Subversive Child Therapist's Open Salon Blog

Today at work I.......

Tue, 6 Apr 2010 21:04:39 -0400

1) Discussed where various gangs have staked out their territories in downtown Cleveland with a client. Today, I learned that I moved between Bloods, Folks and Crips territories. Some of my kids are in these gangs.

I'm beginning to feel like the human equivalent of Switzerland. :)

2) Explored my client's romantic/boyfriend problems. I admire this boy so much. At such a young age (14 years old), he has come out to his family and close friends. There are some adults out there, who are unable to do that!

3) Conducted a memorial service for my client's cat. There were candles, pictures of the cat, and kind words spoken. It was really very sweet and seemed to help my client.

4) Ate a Spiderman cupcake. :) One of my client's parents was hosting a in class birthday party that day. A big shout out for Sam's Club cupcakes!

5) Had a very fun and spirited discussion with my client, who looks just Jamie Fox (I mean--they could be brothers), about the what defines normal, the Twilight series, how to trust others, and Joseph Campbell.

6) Received irritated text from my best friend, who just finished watching Season 1 of True Blood. She doesn't think she acts anything like Tara. I completely beg to differ. We are sooooo Sookie and Tara. Deal with it Steph!

7) Explored with a client about his upcoming case in juvenile court. Explained to him that wearing inmate orange (as he did during his last pre-trial hearing) was not a good idea. I don't care if it was Abercrombie and Fitch.

8) Considered eating another cupcake.

9) Decided against the cupcake. :(

10) Did a very fun art therapy intervention with one of my clients. Makes me remember how much I love love love art therapy!!!

End of day. . .sigh.

Heroic or Just Plain Dumb: You decide...

Wed, 4 Nov 2009 22:11:08 -0500

There are some things they don't prepare you for in grad school as you study to become a therapist:

1) How to prevent a man, who is strung out on drugs, from hurting his girlfriend or their baby or the girlfriend's kids

2)Knowing how to duck and cover, when a client flings a table in your general direction during a group therapy session.

3) Learning a safe way to stop a schizophrenic teenage boy from choking himself.

4)How to conduct yourself as a professional when an angry teenage client comes after you with a fire extinguisher.

5)What to do in case a client grabs you by the hair and won't let go.

Yep. Those things all happened to me. And by some act of god--neither the people or I were hurt during these situations. At least physically. Mentally and emotionally---situations like this take their toll.

What always intrigues me, is what happens to my mind when I'm faced with these situations. I don't know if it's adrenaline but I become a lot braver (or dumber--you decide) than I ordinarily am. I'll jump in and break up the fight, restrain the self injurious teenage boy, calm the scared kids who are listening to their mother's drug crazed boyfriend break down the door.

Then comes the emotional aftermath...but WASP girl that I am: it's all internalized. I get stomache pains, migraines, neck aches. Archipelagos of pimples show up on my cheeks and chin. My eyes get blood shot, my lips get chapped, I begin to stare blankly at things.

Once, the morning after an especially harrowing shift on Ward 10 (when all hell broke loose and the clients all began fighting with one another), a co-worker looked at me with pity and said, "Wow, you look like you're all 'cracked out'!"

I didn't know how to respond to that comment. My knee jerk instinct (which I swallowed back) was to tell my co-worker to "F$#% Off!" At that moment, I was simply happy that no clients or staff had been seriously injured the night before AND that I had a mega large Starbucks Latte in my hand. Plus--I was pretty sure that particular co-worker had never seen someone on a crack bender. Nevertheless, it's hard to maintain professionalism when you both look and feel like a dog's breakfast.

However, that's part of the gig--to remain calm as others fall to pieces around you. Then, when the dust has settled...and the clients/their families are calm, you crawl back to your home/the comfort of your family/friends/pets and...what? Think, process, cry, drink, read, talk to your spouse/significant other/family members? The answer is different for every therapist.

We're taught to maintain professional distance from our clients. "Boundaries" is how it's described in therapy educational literature. And I do, but I'm also human. There have been situations that rattle me:

1) Watching as a 10 year old client sobs and tells me his stepdad physically abused him. Then listening to this same child's bio-mom swear up and down that her son is lying about the abuse, is "crazy", and should be committed to a psych. ward.

2) Sitting with a terminally ill client as she is wracked with waves of pain in her hospital bed.

3) Helplessly watching a teenage client in the first stages of a psychotic break...

And although, yes I automatically internalize negative emotions...I'm also practicing what I preach--finding outlets for my grief, anger, frustration. I wonder if it will get any easier and I won't get so upset by certain cases. Although...I don't think it's good to remove my emotions completely from situations. Maybe one day I'll find the perfect balance. Until then...I'll muddle through.

(Mildly Inappropriate) Puppet Theater

Fri, 23 Oct 2009 23:10:40 -0400

So this is a therapeutic technique I (sort of ) stole from my dad. As a little girl, whenever I would have a problem, my dad would take one of my stuffed bears or stuffed dogs and have it talk to me.

The stuffed dog/bear/whatever, my dad, and I would all take turns discussing the problem together. Looking back with a child therapist's eye, these "talks" allowed me to process the situation in a fun way with my dad, gain understanding about what happened, and plan ahead for how to handle similar situations in the future.

So now--twenty some odd years later--I do the same thing with my clients--sort of....

I call my interpretation:

(Mildly Inappropriate) Puppet Theater

The puppets (at least in my hands) take on a life of their own--sort of like watching... a Jeff Duham skit only for kids...

There are several characters that appear (out of my desk drawer) depending on the client's current problems/concerns:

Mutton (a lamb puppet): He is French, He is cranky, He has several ex-wives, is heavy smoker, and enjoys gambling in Vegas (where he met ex wife number 3), he likes to pet my client's hair (which makes the therapist angry and the kids giggle hysterically), and is frequently the "bad boy" of the group.

(Mutton and I frequently argue in front of clients. The kids love talking to him and are mildly shocked by his behavior. Several clients (one kindergartner in particular) have told me Mutton "needs help". I always ask the clients if they could give him advice about behaving better. Even my clients with the worst behavior are eager to give Mutton advice.)

Bugs (a rabbit): Another smoker (geez--what's with these puppets) with a smokers cough. Bugs is a huge Neil Diamond fan, loves to give hugs, pretends to be tough--but has a heart of gold , and loves to offer advice. He is also not adverse to breaking into showtunes or Sweet Caroline....

The latest puppet to join the others:

The Professor (crafted from a lunch bag and construction paper): A narcoleptic who likes to drone on about the brain and it's chemicals. He's the educator of the group and happily will discuss how meds can help with various disorders like AD/HD, depression, anxiety and so on.

The clients love talking to this crew of puppet misfits for some weird reason. And I am always learning new stuff about the clients and the puppets when a conversation occurs between puppet and client.

Recently, an 8 year old client of mind uncovered that Mutton has been in several bar fights, cheated on wife #2, and used to be affliated with a local gang. Which in turn, led to the client's disclosure that in fact HE had been in several bar fights, cheated on girlfriend #5, and used to be affiliated with a local branch of the Crips.

Just kidding.

But the client did reveal alot of his (previously undisclosed) thoughts about his father's jail sentence.

Who knew....

I blame my dad and his side of the family for the puppet's inappropriate behavior. Case in point:

Setting: Borders Books' Children's Book Department

Dad: Hey, (pulls a pig puppet from the display and puts it on his hand) this is the perfect puppet for your clients with body issues...(Has pig puppet cover its tummy with it's hooves) "I'm fat!"

Me: Really? Um...no.

Dad: (Sliding off pig puppet and putting a two headed dragon on his hand) How about this puppet for talking to those clients who have auditory hallucinations. (Makes the two heads wiggle and pretend to talk) "I'm hearing voices. Where are they coming from", (says head one.) "No it's just me, ha ha ha!", says head two. (Dad starts to snicker, rocks on his heels a sure sign that he's finding himself amusing, and wiggles the heads some more).

Me: Um...again...sick...and no. Are you done?

Dad: It's a learning tool for hallucinations....

Me: Ok, you're done. I'm cutting you off with these puppets. (Quickly taking away the dragon puppet). Let's go before you offend someone aside from me...Which for you is easy to do at this point...

(Oddly enough, I have an 11 year old client with auditory hallucinations who made a similar joke with a two headed clay dog he made in therapy the other day....huh....interesting.)

Dad: How about this squirrel puppet? What do you think Lulu would think?

Me: Dad, my dog is high strung enough as it is...Do not bring in a squirrel puppet in my house. She'll stroke out if she see it. Put the squirrel down now.

Dad: Too late. I'm buying it. (Heads to the cashier).

Me: (Yelling after dad) I'm serious---I am not keeping the squirrel puppet at my house! Even if I put it away in a drawer, Lulu will continue to bark at the drawer and probably manage to open it.

Dad: Then we should probably buy you some baby proof latches for your drawers before we head back. . .

Notes from an Adolescent Psych Ward....

Tue, 20 Oct 2009 17:10:37 -0400

Woke up 8 cranky teenagers.

Broke up a fight between 2 teenage girls. During breakfast. Sigh.

Served lunch to 8 (still cranky) teenagers.

Nearly got killed serving lunch. I now have much respect for cafeteria ladies everwhere. Feeding a pack of teenage boys should be labeled as an extreme sport.

I simply defended myself with my verbal kara-tay and lightening quick ability to smack the boys' hands if they grab at the food.

Convince 6 cranky and sleepy teenagers to attend group therapy.

Hand out what seems like hundreds of writing assignments and early beds (the instituional equivilant of groundings) throughout the day for clients breaking Ward 10 rules.

Get cussed out for handing out all those assignments and early beds.

Hand out more assignments to those who Cuss me out. :)

Chased a moderately retarded 16 year old client around the unit in order to cheer her up. (Oddly, it cheered me up too....)

Threatened to sit on the same moderately retarded girl in order to cheer her up after I became too winded chasing her. (There is a therapeutic reason behind this--don't make me explain. It's a technique I learned from a co-worker.)http://www.grandin.com/inc/squeeze.html

Spent some of my downtime having an amazing conversation with one of my male clients about his life. (To this day--I can still remember everything he told me and it's years later...)

Ate too much candy.

Got excited when the afternoon staff arrived. Especially Big John! There's nothing better than seeing a former NFL!!! player walk onto the unit. That man was like a chocolate wall--and mades all staff and clients feel safe when he entered Ward 10 (or 11 or 12 or 13 for that matter).

Watched several clients dance to the local hip hop/r&b radio station on unit. If I have to hear Soulja Boy one more time...I'm going to scream!

Forced into performing a line dance, The Cleveland Shuffle, with the clients. Did so as I drank my 1000th coffee of the day.

Spent 20 minutes printing out what felt like endless coloring sheets for clients. Do they ever get tired of coloring? Um...no. No matter what ability or gender...our clients love coloring sheets. Can I get a shout out to American Greetings (owners of CareBears & Strawberry Shortcake) and Marvel Comics (Spiderman) for keeping our clients entertained all these years.

All of this couldn't not be done with out the amazing help of the other Ward 10 crew! You know who you are! Love you guys!
End of the day!

When a poop hits your forehead...rough day to follow.

Sat, 17 Oct 2009 17:10:13 -0400

It's 6:45 am on a Saturday. The first shift staff on Ward 10 is staggering in, coffees in hand. The supervisor on the floor that morning gives me a smirk, and says--"Your little buddy, Devon is up and waiting for you. He is having a bit of a difficult morning. You might need these..." He hands me a bath towel and latex gloves.

(A little back story on Devon. He was an 11 year old boy, great sense of humor, and an ear splitting grin. Devon was mentally about 5 years old, per his IQ tests, was developmentally disabled, and had a history of neglect/abuse. Because of his disabilities, a staffer was always assigned to him each shift to help him through his day. The staffers chosen were always the ones who had the best rapport with him, knew his preferences in activities, and knew "Devon-appropriate" de-escalation techniques. I was one of those staffers, hence the supervisor sending me down to talk with him. All us staffers were eager to place him in the autism unit--where we knew he'd thrive. But since he was a ward of the state, clients with private insurance always were higher up on the waiting list for beds. So unfair.)

So back to the scene at hand:

I take a swig of my coffee and inwardly roll my eyes at the supervisor--thinking him to be a bit of a prick. I walk down the hall to Devon's room, where I can hear him banging the walls. Two male staffers are already down there--gloved up and holding towels. I ask them what's with the equipment? They both babble something about getting Devon in the shower, before he wakes up the unit and causes a riot.

I knock on D's door and immeadiately, his head pops out around the corner. If I wasn't so concerned about Devon waking up the unit with his noise, I would have given him a "squish" (my term for a hug") right there and then. Devon had big brown eyes, was tiny in stature, and to add to the cuteness factor--his thumb always stuck in his mouth.

D says, "What's up?" (With the thumb in his mouth. It never ceases to crack me up when he talks with the thumb in his mouth.)

Me: "Morning, buddy. I heard you're up by the noise in your room. Why don't we get you in the tub, scrubbed, teeth brushed, and then you can go play basketball with Mr. Mark in the gym. I'll even bring the radio to the gym with your cds."

Devon:" No." And he shuts the door. More noises--are emitted loudly from his room

Now, I'm getting nervous. If D wakes up the other boys on the unit, they will be pissed. And if I know my boys--they will force their way into Devon's room and terrorize him. Not something that I want to have happening. At all.

Me: "Devon! Open up--I'll get your bubble bath and foamy soap. You can play in the tub. No one's up yet, so you'll have time to play." (Now I know from experience that this child loves bubble baths more than life itself--so I knew I was pulling out my Ace card with that little bribe.)

Devon: (He opens the door--thumb still in mouth and blinks at looks at me).

I inwardly high five myself--I know that look--it means "I"m thinking about your offer."

Suddenly, the door next to Devon's pops open and Josh (a freckle faced little guy with equal parts charm and rage pokes his head out.)

Josh: "Can you get him to shut the fuck up! I'm trying to sleep! He is being too....what the hell was that?"

While Josh was talking, a small dark object flew through the air, hit Josh in the forehead, and dropped to the floor. I look down and my heart sinks. There on the floor is a little brown turd. Oh ....no.

Josh:"That was shit? He hit me with shit. Oh my god!"

Devon: "And there's' more where that came from, BITCH!" He slams his door shut.

Josh begins to laugh and he pokes the poop with his slipper. I sigh inwardly and prepare myself for what's next--Josh attempting to beat the stuffing out of Devon for the rest of the day. I post up by Devon's closed door as Josh lunges to get into D's room. The other two male staffers convince Josh to wash his face in the bathroom, which he does. With Josh in the one bathroom, I manage to hustle Devon into the other bathroom. (By some act of GOD, D agrees to take his bath).

With the two boys both in separate bathrooms, I snap on my gloves and pick up the poop. I enter Devon's room and find three other turds lined up on his pillow--like little missiles ready to be fired. Wow, Devon was right--there was more where that came from....

I collect the poops in my rubber gloved hands, and swiftly walk down the hall to deposit D's "fecal weapons". One of the older male clients, who loves to give out hugs to everyone--approaches me with arms out stretched--blocking my way.

Me: "Not now Daniel. I've got poop in my hands." Daniel jerks back and scrunches his nose in disgust.

Daniel: "Let me guess, Devon?"

Me: Sigh and shake my head.

I plan on consequencing Devon later for throwing poop, but right now--I just needed to drink my coffee. That was too much drama-rama--this morning--even for Ward 10.