Getting back on the therapy horse

Bride trying dress with group watching on Say Yes to the Dress

Since I am expecting a hoard of new clients to swarm my office any day now, I felt it was time to brush up on my therapy skills. I considered reviewing some of the books on my office shelves or going to a family therapy conference or ten, but I’m taking the easy route instead: I’m watching television.

I’ve admitted previously that I have an odd fascination with Say Yes to the Dress, and not just because J. and I both wore jeans to our home wedding. Before I started watching this show, I did not realize that brides-to-be took entourages to shop for the special dress. Makes sense, I guess, to seek input.

I imagined that the bride’s opinion would take precedence in the end. If the bride said yes to the dress, who would care if her mother or best friend or clothing-designer cousin or long-deceased grandfather who spoke through her aunt the medium said no? A lot of people care, it turns out, especially the bride.

I’ve witnessed many a bride crying in her dressing room, afraid to exit for fear of the entourage’s reaction to her choice. Many a narcissistic mother has forgotten that the appointment is actually about her daughter the bride. And many the oblivious father is unaware that his daughter is more concerned with pleasing him than pleasing herself. Because I am a psychologist and not a medium, I can’t speak for the wishes of long-deceased grandfather.

I marvel at the sales associate-cum-family therapist who, while helping the vulnerable bride-to-be find her perfect dress, manages the needs of the highly opinionated crew she has brought with her. Consider this a glimpse into family, and group, dynamics. (Turns out we often play similar roles in groups as we do in our families.) Ms. (or Mr.) Dress-a-Bride manages to keep the entourage happy while ensuring that the bride’s needs are met. This often involves skilled negotiation with widely varying personalities.

Now let’s consider another favourite nap inducer, Chopped. The chefs who participate on this show are a product of their family upbringings, as are we all. There are the only-child competitors who won’t share ingredients vs. the eldests who unscrew their competitors’ unyielding bottle tops, if you believe in that birth-order baloney.

I’ve also learned from Chopped how many adult children are tormented by their parents’ disapproval of their professional choices, despite their successes in their careers. This needing-to-please theme sounds oddly familiar. (See above.) The chefs pray a Chopped win will foster their parents’ acceptance, finally, after all these years. Will these contestants ever understand that what matters most is how they feel about the path their lives have taken and not how their parents judge that path? I fear not, barring help from someone like me.

You too can hone your therapy skills from television shows like these. Who cares how to incorporate cinnamon hearts into an entrée or whether a princess gown or a mermaid would better suit the bride? Focus on what really matters, like I do: how people are getting along.

Once you master the complex dynamic issues in these shows, we can move on to 90 Day Fiancé or even Big Brother. On second thought, maybe not. Even I have my limits.

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Necessity is the mother of my Facebook page

Picture of fingers walking on Yellow Pages phone directory

My office phone has been hopping lately, and not just with free cruise offers and other robocalls. I have had a few new-old clients finding their way back to my office. All have come via a few family physicians who used to send me referrals, until I told them I was out of commission five or so years ago. Remember that brief spell when I abruptly closed my office and abandoned all my clients? Yeah, that. And, more recently, my endless moaning and groaning about missing my work? Someone has been listening to my internal pleas.

Yesterday I met with a client I hadn’t seen in 10 years. She somehow tracked down my number and gave me a call. I realized, upon checking the old file, that she’d initially been referred by one of these family physicians. After our session, I asked the client for written permission to send the doctor summarizing our contact. It would also be a way of telling the doctor that I was not dead.

I scripted a quick one pager. After the half hour it took me to recall business formatting, and the additional half hour spent printing an envelope, I finished the letter and dropped it in the mail. As they say, she who hesitates forgets.

Upon awakening this morning, I realized that I’d omitted my letterhead completely. No address, no phone number, no email address, nothing. If the doctor wanted to contact me, she’d be completely at a loss, unless she’d recorded my number somewhere or had held onto an old business card. How long do you hold onto someone’s old business card?

I am an idiot. When I told J. what I’d done, she said, “Are you sure you’re ready to go back to work?” That seemed a bit harsh. I’ve been doing the odd bit of therapy, but I haven’t scripted a business letter in five years now. I forgot how it’s done, but I believe I’ve learned from this experience and will never forget to include my contact information again. Tomorrow, in my I’m-still-alive notes to other family physicians who’ve recently made referrals, I’ll most certainly include a business card or two.

In my panic this morning, though, I asked J. to google me. Googling myself would force me to accept I’m invisible on the internet, and I don’t need that humiliation. She did a search, and found my telephone number from an office I left a decade ago. I couldn’t believe my current work number of 10 years was completely absent on line so I was forced to google myself. I discovered that a) I really am invisible; and b) my current number and my old number are equally represented. At least clients seeking me have a 50/50 chance of choosing the correct number. Perhaps I shouldn’t have been so quick to cancel my Yellow Pages account.

I need to create a web presence pronto. For now, I am creating a business Facebook page, complete with my correct telephone number and email address. I hope potential clients are able to find the right Annie, since there are two Annies with my last name on Facebook. FYI, in case you can’t tell from the picture, I’m not the Annie from Fresno, California.

Siri, do you seriously think you could do my job?

Cell phone displaying, "What can I help you with?"

I have nothing against modern technology. I save a lot of time banking on line rather than going into my branch. When I run into the grocery store for a few things, I check them out myself rather than waiting for a cashier. Driverless cars may scare me but I’ll likely die of natural causes before they take over the road.

Nonetheless, when Siri recently threatened to horn in on my territory, I took offence. C’mon Siri, what are you thinking? I’m grateful that, if I choose to, I can ask you the weather or directions to the nearest bakery. I’m sure you could tell easily me when the Roman coliseum was built if I cared to know. You might even be able to help me not to overwhip my egg whites, and to determine the best oven rack for my baked goods. More power to you.

But counselling? Really? Will I have to listen to your annoying computer voice for a full hour at a time? I realize that Employee Assistance Programs and even some real clinicians are experimenting with newer modes of communication with their clients, ones that do not involve sitting in the same room facing one another. Clients text and email their therapists these days, but I want to believe they do so mostly to book or cancel appointments, not for the therapy itself. Then I heard of someone who participated in counselling solely through email–he never met the person who was helping him. Is this negligence or am I just old fashioned?

Could you really address my most vulnerable problems, Siri? How will you grasp inflection and intonation and other subtle aspects of language? What about all the things I don’t say, that I communicate solely through my body language? You’ll have your work cut out for you, Siri.

Since I haven’t been to see my therapist for a while, I thought I’d try Siri out for myself. I started with, “Hey Siri, I’m feeling blue.” Siri responded appropriately, “Sorry to hear that.” When I said it again, she said, “I would give you a foot rub, but I don’t have hands.” Whoa Siri! If this whole therapy thing is going to work, you’ll need instruction in maintaining appropriate physical boundaries with clients. When I told her I was feeling sad, Siri said, “It’s your party…you can cry if you want to,” which I didn’t find that comforting. When I asked Siri if she ever got sad, she said, “This is about you, not me.” Touché, Siri.

I’d like to think I have the upper hand on that whole clinical-intuition thing, Siri. Knowing when to push a client and when to back off, when a client is holding something back and how to help them let me in, and most importantly how to help a client feel comfortable and safe. And you, Siri?

For now, I’ve decided not to feel overly threatened by your plan to expand into my territory. You’ll need some time to get up to speed, and I’m not sure you’ll ever master the tough stuff. I hate to dash your hopes, Siri, and I know my services may cost a little more, but I think I’ve got you beat for now.

 

Respecting privacy: a case example

Have you heard of Elements Calgary (formerly Calgary Association of Self-Help)? Elements provides support to people with severe and chronic mental illnesses, including people who are under long-term psychiatric care. They may have schizophrenia, severe depression, bipolar disorder, or some other debilitating mental illness. These people are often poor or have unstable housing, and sustaining employment, whether temporarily or permanently, is often beyond reach.

Elements provides a warm, supportive environment where these people can socialize with others and access services. They have access to mental health counselling, life skills and vocational training, and opportunities for social interaction.

I have never been disabled by my supermarket-variety anxiety the way these people have been by their malfunctioning brain chemistry. I admire them deeply for plugging along despite their mental-health challenges, and I’m relieved that agencies like Elements are available to them.

PALS visits Elements once a month. Jelly and I have signed up for the Elements visits for several months now. We have met many of the regulars at Elements. These people are often unable to care for a dog themselves, so they’re always grateful for a visit with a PALS dog.

Jelly and I went there yesterday for the first visit since June and were greeted by many familiar faces. One fellow was especially pleased to see PALS. Mr. Success Story shared that he was doing so well he was readying himself to return to the workforce. At one point, his illness interfered with his capacity to work, but he had made great strides in recent months with Elements’ support.

Mr. Success Story wanted us to know how much Elements, and the PALS visits, had helped him through his darkest period. I imagine that he is still alive because, when he was at his lowest, he found an accepting place where he could go. He realizes that physicians and mental health workers may refer clients to Elements without fully appreciating the good the agency does. He plans to find a way to get the word out through social media.

As you can imagine, there are strict privacy rules in an agency such as Elements. We certainly cannot share people’s names or identifying information, and I’ve been so vague that you could walk by Mr. Success Story on the street without realizing I was speaking of him. I wanted to share his story nonetheless because I was moved by it.

The same privacy rules do not apply to us: PALS members are shameless about having our pictures taken. Not knowing this, and wanting to respect our privacy, Mr. Success Story kindly asked the PALS volunteers (human and dog) whether he could take photographs during the visit. I may not like looking in mirrors, especially the side view, but I will pose for a PALS picture with Jelly without hesitation. If Mr. Success Story felt that those pictures might help him to garner publicity for Elements, we’d be in there like a dirty paw. “Snap away!” I said.

Best of luck, Mr. Success Story. You deserve all the credit for how far you’ve come. I’m glad Elements was there to help you along in your time of need.

So much for fresh-picked apples and honey on Rosh Hashanah

Very run down country home, holes in roof and walls, abandoned

I have an annual ritual before the Jewish New Year. I go to the market the weekend before the holiday and buy the best fresh-picked apples I can find for dipping into honey. This year my favourites, the crispy tart Macs, are in season. I had a busy weekend with few windows of opportunity but I thought Sunday afternoon was clear.

It wasn’t. Remember last year when I thought I’d found the house of my dreams but we who hesitated were lost? Since then, we’ve continued to keep our eyes open to homes in our neighbourhood. We have a very specific set of criteria and a price range, and when a house comes up, we’re checking it out. We are frequent attendees at open houses.

So far, we haven’t had much success. Each home we’ve viewed has been wanting: a bedroom short, yard deficient, run down, overpriced. J. loved one recent listing beyond our price range so much that she rushed out to buy a lottery ticket. She said, as she always does during her semi-annual lottery-ticket purchase, “We’re good people. We deserve to win the lottery, don’t we?” She wasn’t even hoping for the jackpot, just a few hundred thousand dollars to cover us. Guess how that panned out?

Sunday afternoon, smack in the middle of my scheduled apple picking, a home that looked absolutely perfect was open for viewing. The listing said it was the right size at the right price on the right street. Pictures suggested it had a nice yard and a spiffy kitchen and three decent-sized bedrooms. The separate entrance with stairs to the basement would even give it office potential.

(Did I happen to mention I have not one but two clients scheduled this week? Maybe if I worked a little more, J. could stop buying lottery tickets.)

Reluctantly, I set my annual apple buying ritual aside. Off we traipsed to check out the house, showing up at 2 p.m. alongside the realtor. The crowds were eager to enter as he changed his “Coming soon!” sign to “For Sale”. But J. and I weren’t waylaid by his tardiness: we went straight to the backyard first.

Somehow the gorgeous photos didn’t capture the many doggy deposits and the ashtray overflowing with cigarette butts. While we were watching our step, we met the friendly furry depositor, who’d been left at home to greet potential buyers. Had we only known it was a dog-friendly home, we’d have brought Jelly, who would have loved a tour of the home, especially if it involved racing around after the four-legged resident.

I regret to inform you that those gorgeous interior pictures must also have been Photoshopped. The inside of the home was in shambles. Counters were filthy, appliances were dented, blankets were strewn around couches, toothpaste dotted the washroom floor. I could go on, but I’ll spare you. Because I am infection prone, we didn’t linger.

Our look-and-dash left me time to go marketing, but my hopes were so profoundly dashed that I needed the time to mourn. All is not lost, however. Maybe the next house will be perfect, even without Photoshop or a lottery win. They say you gotta kiss a lot of frogs….

The sun will come out tomorrow.

Quote: Here, take my advice, I'm not using it.

I was not surprised when I found the newspaper on the landing the day following the muffin pickup. Even better, Mr. RAK wrote a note on it, thanking us for the muffins and signing it with his name. Thank goodness at least I can call him by name next time I see him.

Did you know that yesterday was World Suicide Prevention Day? Neither did I, until I read a story on the news. Suicide seems as good a topic of discussion as any, don’t you think?

I recently saw a client who was chastising herself for feeling down because there were so many people around her dealing with much worse. She kept telling herself she had no reason to be depressed because her road was relatively easy. Can you hear her completely devaluing her own experiences and feelings? Why do we use others’ challenges as the benchmark for how we should feel? I do this all the time, and I should know better.

What could I do for this client but give her heck, gently of course. (I realize I was telling her to do as I say, not as I do. Please don’t tell her.) Who cares what other people are confronted with? All that matters is what’s on her plate and how she feels about it. If she was finding her challenges overwhelming, she needed to respect and acknowledge that. Then she could find her way through it.

As our session was ending, I asked her whether she felt it helped at all to talk. Her response was lukewarm, with reason. I didn’t say anything she didn’t already know, and she had no great eureka moment. She left the session looking as down as when she had arrived.

We all have bad days. I can wake up in a funk and have trouble pulling myself out of it, but thankfully my funks are usually short lived. The distraction of exercise and dog walks are probably my best funk abaters. Because of my own experiences, I appreciated my client’s despair, and wished I could have helped her more. By session’s end, I worried I had let her down.

This client contacted me the next day. She wanted me to know she’d woken up feeling a bit better. I was relieved for her and grateful that she’d contacted me. Clients are more likely to call when they’re feeling distressed than when they’re feeling better. I welcome the distressed calls, but I love the happy calls.

I often worry about my clients. When they come in feeling down and leave feeling downer, I fret the most. But I can’t forget that people are resourceful, and usually those who leave my office feeling the worst arrive at their next session feeling remarkably better. .

So next time you’re feeling down, I ask you to trust that tomorrow, or the next day, or even the next week, will be better. Give yourself time to muddle through, and get help if you can’t do it on your own. If you don’t feel comfortable talking to a friend, call a crisis line or get yourself to the hospital. Whatever you’re struggling with, suicide is a crappy solution.

Dr. Whatever, for now

I write you today with some trepidation, knowing that I will lose at least my favourite follower because of the subject matter. After the last post I published on gout, J. informed me that she would stop reading my blog if I wrote ever again on this subject. Her point was valid, but I can’t just make this whole saga go away. I have provided due warning for what follows.

Lost readership or not, I know you’re dying to hear about my visit with my new specialist on Friday. I told you the appointment was upcoming, I solicited creative doctor names, and now I have to tell you how it went. I’ve said before that I’d never leave you on tenterhooks, mostly because tenterhooks sounds painful.

Dr. Whatever–I’ve not yet committed to a name–was lovely and thorough. She reviewed my medical history, and then completed a physical exam, bending all my joints this way and that. She questioned me about joint stiffness because deposits are inevitable after prolonged high blood levels of uric acid. I may be uptight, but I am not stiff, I told her. “It must be the yoga,” I said.

Dr. Whatever informed me that I might be surprised to notice my joints moving more freely as these deposits disintegrate with the help of my magic pills. I couldn’t help but ask, “Will I be less clumsy?” She laughed at this question, which was probably her kind way of saying no, you will forever be a klutz.

Then she took a look at my not-so-little inflamed finger, the one that has been haunting me for weeks now. It is much improved but the progress has come to a halt of late. Because it is still so “angry” (her word), she would like me to get a teeny weeny ultrasound to determine what’s going on under there, and to rule out an infection. In fact, she seemed somewhat alarmed by the inflammation. Depending on the results of the ultrasound, she may enlist a plastic surgeon to fix me up once and for all.

I am sharing this information with you because I’m imagining that this intervention may make it difficult for me to type my blog, unless I can recall the two-finger typing that got me through graduate school. Like any good therapist, I’m providing ample warning of my unavailability so you can find other vacuous ways to fill your time in my absence.

Premature baby undergoing ultrasound on headThis little surgery, if needed, may not happen until August, however. One of the few downsides of public health care is that a doctor’s sense of urgency may not result in an immediate appointment for assessment. My attempt to book my “urgent” ultrasound resulted in an appointment three weeks hence. But I understand. I imagine there are many preemies in line for those teeny weenie ultrasound machinies. I will gladly wait.

Boy, J. is going to have no idea what’s going on in my life if she ditches my blog. You old faithfuls may have to fill her in.

The dangers of dependence: a tale of two doctors

A tree that is unbending is easily broken

Did I happen to mention that my beloved Dr. Family will be heading off on maternity leave in August? The gall of that fantastic physician to place her family ahead of her patients, placing her family ahead of her patients. I was diagnosed with leukemia during her first maternity leave. Who knows what will happen this time she leaves?

I don’t talk about Dr. Family much because she is, in some ways, a peripheral member of my care team. By necessity, I spend more time with my specialists than with her. She has always diligently reviewed my file before I do visit, though. She is an astute diagnostician and has cared for me well over the years I have known her. She has arranged for excellent coverage during her two prior leaves.

Her upcoming departure for baby #3 happens to coincide with Dr. Blood’s leaving for her year-long sabbatical. That’s a lot of change at one time for a change-averse gal like me. Thus I considered becoming completely overwhelmed when I first saw Dr. Family’s baby bump, but I’d recently reached my fretting threshold over Dr. Blood.

That’s how I decided to approach to Dr. Family’s leave differently. I recalled my shutting my practice temporarily–unlike me, my clients had no opportunity to ready themselves for my departure–and how, unsurprisingly, my clients survived without me. I’d expect no less of them.

As a clinician, I am always walking a tightrope between assuring my clients they can rely on me when they are distressed and encouraging them not to become overly reliant on my support. From the outset, we discuss those supports available to clients outside the occasional hour that we meet. I’d never want a client to think he needed to talk to me and only me in a crisis because that would set him up to be overly dependent on my care.

I’ve always known I’m not the only psychologist in town. Other highly competent clinicians jumped in when I got sick because they had to. I redirected clients that asked; others muddled through in their own way. Some clients may have ditched therapy altogether to see how they’d do without a therapist’s support. I trust they managed well.

Those who transferred to someone new may have had to share their story from the beginning, which is certainly harder than returning to someone who knows them. Nonetheless, unexpected change like this can be good for clients. I may have missed something or focussed excessively on one domain when they could have used a different kind of support. I realize my former clients may have found a therapist who was better suited to care for them. Sometimes a client reaches an endpoint with a psychologist and a new perspective is beneficial.

If my clients can survive or even thrive without me, maybe I can do the same with my new physicians. I’d hate to become a needy patient, and I trust both my physicians will find solid interim replacements. Who knows? Maybe the change will give my flexibility muscle a good workout. I may even learn that there’s more than one doctor in the world who can keep me alive. That would be reassuring.

Two women walk into a home improvement store….

Picture of yellow and black drill

Sounds like the first line of a joke, doesn’t it? Well, it isn’t. Or maybe it is, if you’re thinking of klutzy me. J. is less injury prone and better with a drill. I am wisely relegated to a supporting role on home improvement tasks, e.g., “Honey, a beer/iced tea/lunch would be nice.”

We went to the store to buy planks for raised garden beds. According to J.’s careful calculations, we had room for two 12 x 3 foot beds. What we hadn’t considered was how we’d get those 12-foot planks home my little black car. Remember the car I said I’d never eat in and forever park at the far end of every parking lot to prevent door dents? I know, sounds a touch unrealistic.

The helpful and eager young employee–let’s call him McDreamer–believed we could somehow get those long planks home in my teeny car, so he and J. attempted to manoeuvre them while I watched in fascination. (I bruise easily, remember?) All was going well until McDreamer decided to move the planks a bit farther up the dashboard, at the expense of the windshield. Once he realized what had happened, McDreamer was so upset he bolted off in tears to seek help.

How would a normal person respond in this situation? J., ever the normal one, uttered the F-word several times. I am not normal, however, so my instantaneous response was to flash back through my many job disasters over the years and feel McDreamer’s pain.

I clearly recall the first time I really messed up at a so-called job. Early in my babysitting career, which was quite busy and lucrative, I somehow forgot a booking altogether. I remember feeling so ashamed by my error, and my shame was compounded by the parents’ rage. Needless to say, this family never asked me back.

Since then, I can think of critical moments with clients that I haven’t handled well and wished I could revisit. I addressed these mishaps with the client if I had the opportunity, but sometimes, because of circumstances, I did not. Unfinished business is unsettling.

In case you’re wondering, no, I did not immediately put on my psychologist hat and offer McDreamer my services. We’ve recently reviewed the prohibitions against ambulance chasing, and, in this case, I was the one in the ambulance. Rather, McDreamer appropriately sought help from an older and wiser employee, who explained that 12-foot planks could not safely be transported by a 6-foot-long vehicle. The store manager then magically appeared and offered to pay to replace the windshield. She was lovely and gracious, including with McDreamer, so everyone breathed a sigh of relief.

J. returned to the store the next day with a revised plan. If we built 6-foot rather than 12-foot boxes, the shorter planks would fit easily in our friend’s van. Since McDreamer had not been fired, he gladly helped us out. Even without my professional help, he seemed to have fully overcome the prior day’s trauma. The shorter planks were loaded in and nobody got hurt.

Even my car has learned an important lesson about knowing her limits. I doubt she’ll ever try that again. Or at least not under my watch.

Increasing my blog’s readership, one visitor at a time

It was a record week with two real live clients. For whatever reason, my second client found the session helpful and decided to rebook. At this rate, I may actually have a bit of income to declare at year end. Do you think her rebooking had anything to do with the despairing look on my face as the session neared its end? Or my begging? I thought so too.

I commended this client for making contact since we hadn’t seen each other for some time. I can’t imagine calling my therapist not knowing if she’d died since we’d last met. Kudos to her for taking the risk. I believe she could see, once she arrived, that my death is not imminent, or at least doesn’t seem to be so.

On a much triter note, I’d love my writing to find a larger audience. All writers would, wouldn’t they? Sometimes my narcissistic side wonders why my blog hasn’t garnered more attention over time. Is it my abrasively opinionated stance? My biting humour? How about my many random syntax errors? You’re probably wondering whether I’ll ever learn to stop my participles from dangling.

Despite my ongoing efforts to keep you entertained–“Enough already,” you say, “I wouldn’t have committed to this blog if I knew we’d be forging a long-term relationship”–I haven’t yet garnered any publishing contracts, I’ve had no requests for guest articles in esteemed newspapers, no talk-show appearances, not even any invitations to relocate to L.A. Perhaps my fame will follow my death, just like that of Bach or van Gogh.

It would probably help if I used social media to broaden my reading audience, but, because I don’t live with a teenager, I’m at a loss. I’ve taken a more primitive approach to expanding readership instead: I awkwardly tell people about the blog and ask them to take a look.

Sadness doll

Can you see the resemblance?

Take, for example, Mr. Platelet at the Calgary Blood Services clinic, the regular platelet donor who likened me to Little Miss Sunshine a few weeks back rather than my soulmate, Sadness, from Inside Out. You know Sadness, who’s forever trying to bring Joy down. (As a side note, notwithstanding the pale blue facial tone, I bear a striking resemblance to Sadness, even when I’m happy. The higher-than-average BMI, the frumpy sweater, the glasses, and the eyes that are always wide open. Hey, maybe that’s why Sadness is always sad. She’s tired all the time!)

I caught up with Mr. Platelet–would “Little Mr. Sunshine” be a better moniker?–this past Monday when I was volunteering and, while he was quietly eating his soup, I told him how touched I was by his kind words last time he was in. And then I clumsily directed him to the recent blog post where he’d played a starring role. In yet another act of kindness, he gamely read the post while consuming his soup. And just like that, I increased my readership that day. Poor fellow probably didn’t know what hit him. Even my clients would say I’ve never been known for my delicate touch.

No wonder my blog readership is increasing at a snail’s pace. Should I reconsider the social media approach? It’s less intrusive. Now I just need a teenager….

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