Hello friends,

   On this stormy Friday night I find myself feeling disconnected from the world and wanting to reach out.  I'm also processing a lot and itching to write about a situation I had with the counseling center on campus and I want to share that and the conclusions it brought me to with y'all.

  As a wounded healer I'm just now arriving at the point where I'm integrating my "wounded" and "healer" parts. There are some days and things where I am definitively wounded and some days and things where I am definitively healer. One of my definitively wounded things is that for the last 3 semesters I've been a member of the survivors of sexual violence group through the university counseling center at my school. It's been a really challenging-in-all-the-right-ways experience. It has definitely illuminated many things for me as well as provided a space to sit with my identity as a survivor of sexual violence and what that means. Because of some staff transitions and maternity leaves and such the group for the current semester will be run by different staff counselors than in the past. At the end of the last group the facilitators brought in one of the counselors who will be co-facilitating the group the next time it runs. It turns out that I knew this person, we'd had a class together just the previous semester. This person did a practicum with the counseling center as part the clinical psych program on campus and then was hired on. Because I'd talked to this person before when we were in class together I knew that one of their interests was sexual violence. I imagine that's why they inquired about the group.

   So here's the thing about therapy and therapy groups-confidentiality is really important. So important that it's sacred, it's considered a foundational principle of therapy. It's so important that it transcends all theoretical orientations and modalities of therapy. It's literally the one thing all mental health professionals can agree on. By hiring a person who was literally weeks ago a student of the university that the counseling center serves, the counseling center puts itself in a situation where they need to consider the ethical implications at play including confidentiality, dual relationships, power dynamics etc. And not to be a bitch but they really failed here. They were remiss in their calculation a former grad student would be a good fit as a facilitator considering the groups are mixed between undergrads and grads and also considering what a small university it is. Please understand that I'm not saying they should have known I'd had a class with this person. I'm saying it's clear that they were remiss in thinking through what the potential outcomes are of hiring someone who again, literally weeks ago, attended this school are. My position is not that this person should not have been hired, it's that there should have been more thought around what ethical implications might be on the horizon with them as an employee. I'm just saying all they had to do was think about it.

  When I saw this person walk in the room and initially made eye contact with them my heart sank and I felt so ashamed. I had sat in class with this person for a whole semester. While I am somewhat open about my history of trauma it has to be my choice to do so, and my very presence in this group tells all others present something about me. I consented to being in the group, I did no consent to that information being shared with anyone unless I was the one doing the sharing. In short, it felt awful. Tears of embarrassment and shame for needing help pooled in my eyes and I let my hair cover my face. I looked at the floor until they left the room. I felt totally silenced and so ashamed.

  This was weeks ago. I made a mental note not to do group in the fall, obviously, and just pushed all this under the rug. I just didn't want to talk about it, I guess I was too upset. Fast forward to the beginning of the semester and the other co-facilitator emails me and asks me if I'm interested in group. In my head I'm immediately like "NOPE." But as I think about it I become angry. I like this group, I was here first. I don't want to not go, and I'm still hurt about them exposing me as a group member. I made the choice to talk to someone I'm close to about it and she advised me to advocate for myself and tell the counseling center what happened. I ended up doing it but I didn't want to. I waned to just quit and not tell them why. But I did it, I made an appointment with the person that contacted me and I told her what happened and how I felt. I hated doing it, all leading up to it I felt like I was going to throw up. The 20 meeting threw off my entire day because I was so anxious both before and after. She apologized, and she understood how I felt.
Just writing this is making my stomach churn again.

   Anyway, she mentioned that a possible option was having the new practicum student (from WashU, not our school) co-facilitate the group instead of my former classmate. While I sincerely appreciated her efforts to try to make group something I wanted to do, I became angry at the idea of a practicum student co-facilitating the group. In my head I was like "I'm a practicum student. That's weird." First they mess up and expose me as an sexual trauma survivor, and now they want to add a practicum student? Yuck. Then I immediately flashed to people in mental health saying they want to work with trauma. That narrative of people sort of glamourizing diagnoses and pathologizing people's experiences presented itself. Only this time I wasn't experiencing this narrative as a metal health professional/peer, I was experiencing it as a client. And I became enraged that my personal experience and my need for a therapy group would be in relationship with someone's education and clinical interests. And then I considered that I'm a huge hypocrite, because I am also a practicum student and I also have clinical interests and I also have clients who are teaching me. I have even sought out clients because I wanted to work with their specific diagnosis. Mentally I immediately begged the universe to forgive me for participating in mental health in this way.

  Being on the receiving end of services in these ways- being exposed by my therapists and then potentially participating in a group co-lead by a practicum student- has been eye opening and very humbling. It's also made me very ashamed. Not just because I was exposed, but also for the way that I have acted. It has given me a sense of gratitude for my clients who have shared their hearts with me, even when they understood that I was in-training. Recognizing the narrative of pathologizing and the sort of voyeurism that exists around certain diagnoses (Dissociative Identity Disorder, for example) has been disturbing me for several months but it all came to a head when I felt like I was on the receiving end. It's never felt right to me to use the word "population" to describe people and I always feel so out of place when I'm asked what kind of work I want to do post-graduate school. Thinking about all of this I sort of have an answer. The truth is that I want to be with people. I want to be with people, expand their coping skills, hear their stories, feel their pain with them, feel peace with them. I just want to be with people, I just want to connect.

 So, be careful out there friends. Remember that the people who seek services are people, as cliche as as that sounds. Not a diagnosis, not a set of symptoms you might find interesting or hate. And their willingness to be with you and to trust you even at the most basic level, like showing up to your session, is a big deal and it shouldn't be taken for granted. It takes a lot to even begin to let someone in. For me this whole experience has been a very pointed reminder that there is virtually no difference between me and my clients. I have grown in my gratitude for their trust and also grown in my respect for them. I happen to be the therapist, they happen to be the client. In other circles in my life I am client, and someone else is the therapist.

Good night friends, thanks for reading <3


 



 



     As I approach the last year of grad school (is this real life?) and mark my one year at my current job I have lots of thoughts on working in mental health. Not in any particular order, here are 5 thoughts I have every single shift and every day at practicum:


1. Why is the world such a terrible place and why do terrible things happen to people? 

There is a strong correlation between adverse life experiences and prevalence of mental illness in a person's life. Honestly sometimes the things that I hear make me want to curl up in the fetal position because it just hurts so much knowing that someone has had to experience such difficult things. Sometimes I'm just at a complete loss. Like why? Why does this have to happen? Why does it continue to happen? Will we ever be able to stop it?

2. Am I helping? Like at all? 

One time one of my professors said "Therapy is such a crap chute sometimes. You never know who you help, if you help at all." I was actually very relieved to hear this, as it reflects my own experience for sure. Sometimes I get home from practicum or work and wonder if I did anything that mattered that day. It's not that I need to know for sure that I helped someone or that I need to be recognized for doing that, it's that it's important to me to both push and support my patients and my clients in the right ways. I don't always know what's right. Sometimes you just come home thinking you didn't do anything right that day and at best the world is no better off than before you came in. It's a sucky feeling.

3. What if this person doesn't make it? 

I think about this a lot. By "make it" I mean in physical sense and an emotional one. Working with eating disorders (the most deadly category of mental illness) definitely introduces the idea that some of our patients will die due to the extreme stress of the disorder on their bodies. But I also mean "make it" as in be happy, have a life you want that's not hijacked by anxiety or trauma or depression or whatever it might be. To be very honest with you, this thought is the one that disturbs me the most. I have to push it out of my head and just proceed as if everyone I interact with will make it, even though I know that statistically that's unlikely. I think this is such a big thing for me because I have a lot of fear around what my life would be like if I hadn't made it to recovery. I physically wouldn't be here, and even if I was I'd be just a ball of anxiety, depression, panic, and self-loathing, Or in other words not happy in the slightest and not the least bit satisfied with my life. Nothing I would ever wish on anyone and something I'll forever be working to avoid.

4. I just want to take you home. 

I think this all the time. Not about every patient and client, of course, but there are some that just tug at your heart strings. And it's not just kids either. This past school year I had a client who was older than I was and way taller, and yet I just wanted him to be mine to care for. This happens at work too. Sometimes I want to take people home with me because I feel like their families/support systems suck and I don't think their parents are even worthy of them. And I think I can do a better job supporting them. And sometimes it has nothing to do with their support system and it's just because I really love this patient/client because they have a great personality and I genuinely love being in their presence. And sometimes it's both. I think I have this fantasy that I'll take people home and everything will just be okay. Then I remember two things: 1. I can't even get myself to shower every day so I really have no business being responsible for other humans and 2. I can only give what I can give, and what I can give is enough even though I often want to give more. And I also know that doing this, even if I could, would likely not solve any problems.

5. Am I going to be able to do this?  

Kind of in the same vein as #3, I often wonder if I can handle this. I especially wonder this on the hard days or days where triggering things are happening. I wonder about my own recovery and if I'll be able to maintain it. How will the stress from work affect me? Have I worked my own stuff enough to be able to be present for others as they work through their stuff? What do I need to be okay doing this work? What are the indicators that I need to ask for help? And how will I do this and who will I ask? What are the consequences of ignoring my cues? While I'm at work/practicum I compartmentalize. If things start coming up for me I wall it off in my head and focus on my clients and patients. This works extremely well. The problem is I get home and kinda freak out cause all the levees break in my head. Over time this builds up. When I'm in the moment with people, this question doesn't come to me. It comes to me when I'm forced to be present with my own emotional reactions to tough situations. And sometimes this thought occurs when you just feel defeated and like nothing your doing is making any difference at all.

It's tough this field we're in. You never know if you're going to a get a day where things are going alright and the world seems like an okay place or if it's a day where it's just all gone to hell and we should just stop it somehow before things really get bad. Either way these are the questions I'm often asking myself.

Thanks for reading, friends!








       Based on a conversation from earlier today, I started thinking about the closet full of ghosts that all therapist's have. This ghost closet is conceptually similar to a skeleton closet, though not exactly. It's not really a skeleton closet in the sense that this is where all of our past bad deeds or moments of questionable judgment are kept. But the ghost closet is that space within us where we keep all of clients that we didn't get to say goodbye to, all of the clients for whom, for whatever reason, there wasn't a proper termination.

     My career so far has been short, (arguably it hasn't begun at all) but still I have several ghosts of client's that haunt me. I have moments where I remember these clients and remember that we never got to say goodbye and I feel this pang that makes my heart slightly fold in on itself. I don't have these moments so much that I am unable to be present or unable to connect with new clients and those around me, but I have them frequently enough to never really forget the clients the ghosts represent either. For me, these clients are in limbo; gone from my practice and from my physical world but nowhere near gone from my heart or mind. I find this discrepancy deafening. This phenomenon of the ghost closet often takes on physical form because we're art therapists and frequently left with the art work of our clients.

     As a student therapist I sometimes observe that I seem to feel things bigger than the professionals in my field. I just seem more sensitive, more likely to feel surprised, and more likely to feel in general. It's not that over time people learn to care less, they just gain experience with all of the potential outcomes of a therapeutic relationship with a client. Since I'm new at this, I don't have much experience, I'm only just becoming aware of what the different outcomes are. And every time one of them plays out it's usually the first time that's happened to me. Even in my inexperienced state, I know that clients coming and going without notice is par for the course. I know that this could always be your last session with a client. While I have internalized this, no amount of knowing that it could always be your last session prepares you for when you find out it actually was your last session.

     I feel like generally speaking I get really close to my clients. Yes, it's very boundaried and yes we're close in very specific kinds of ways but close is close. In order to fully connect with them I must be unequivocally connected to myself. This connection loop, that starts with me to myself and then extends to my client, makes you get close. We're basically in a trust loop. I trust me, I'm inviting you to trust me too, and to trust yourself while I trust you. These connections are powerful and raw, and when they suddenly end it's sort of tragic and maybe even traumatic. As the therapist in the loop I'm left with this feeling of un-finishedness, sadness, and grief. Yes, I can do my own work and settle my feelings as much as I can about the abrupt end, but there is some part of me that will always grieve these clients more than the ones that I got to properly terminate with. There's something about those clients that stays with me in this place that they can never move out of because our connection was still present, still live, when they left. Neither of us had time to properly tuck in our connecting parts and say our goodbyes.

  It's like holding hands with someone. When you're actively holding someone's hand your fingers are interlaced or your hands formed around theirs. When you let go your hand returns to a resting position. But what if one hand was suddenly just gone, if it suddenly disappeared? At first, the remaining hand would still be molded to the hand that disappeared. The remaining hand may search for the other hand, the newly exposed skin might feel a slight breeze. For me, this is what it feels like to not get to say goodbye. My "hand" is still in the position it was in when we were holding hands. And in some ways, it will always be that way. There's some part of me that will always be waiting for the other hand. There's some part of me that will always be wanting to plan letting go of each other instead of one hand just disappearing. Because I'll always be waiting, these clients don't live in the same place in my head or my heart as the clients that I planned to let go and planned to let go of me.

  So what do you do when you don't get to say goodbye? I cry. A lot. And I draw. And I find myself wanting to talk about it. I find myself wanting to tell my mentors and supervisors about my client and the work we did, about how it feels now that they're gone and about the hope that I have for them. I find myself wanting to sit in my thoughts of my client and be with them that way. I fantasize about expressing my anger to the person that represents the circumstances under which my client had to leave. I recite in my head all the things I would have said if I'd known it was our last session. And then I cry some more.

   I'm writing all this because I'm trying to figure out how to be okay with being vulnerable and authentic in relationships that are fairly unstable. I'm worried that if I can't learn to comfort myself and cope with the grief of unexpected termination then I won't make it as a therapist. I don't want to burn out because I never learned how to cope with not getting to say goodbye, because unexpected termination is a reality in the field we're in. So while I'm getting used to the reality that this is going to happen, I'm far from it not affecting me. It seems like the only thing I can do to keep myself balanced is to be true to all of these feelings when they occur. Acknowledge those painful, heart-folding moments and then spend some time remembering why it hurts. Don't expect to feel better and do learn how to hold that this wound may bleed for a while. I think I'll be more worried about myself  if I ever don't have a response to an unexpected termination than I am right now. Because if I don't care that someone's gone then something has gone awry. When I think about it like that I'm okay with continuing to work on this. My supervisor at school told me that if I'm feeling disappointed that the relationship is ending (or in this case has ended), then it was good work. There's rapport and connection there. So that's something to hold on to. It was good work. But I didn't get to say goodbye. I didn't get to package our work and review all of the gains. And I didn't get to convey that it was truly an honor to be with this client. And that's the part that stings.