What to say

Thursdays are my busiest days. It doesn’t change whether it was 7 years ago working in senior day facilities, running substance abuse groups for teens, or the past 6 years in school based services. Now, working in an office with scheduled clients, a hair-breadth away from private practice, it’s the same deal.

Clients cancel 1-24 hours in advance, don’t show up at all, or reschedule early in the week. Mondays are notorious for being empty. In the therapeutic line of work, empty is boring. I plan sessions for my clients, questions to push them towards progress. I create home practice to be completed between sessions and built upon the following session.

On the internet you can go to any search engine of choice an type in “therapy client no show” and get advice. Many of the results present advice for ffs clients (fee for service). What about medi-medi clients who have no co-pay?

I make a phone call about 15 minutes into the missed session. I offer them an opportunity to reschedule the following week. I ask about problems arranging transportation and make recommendations. If I end up leaving a message, it’s “Hi XYZ, it’s Megan from [insert employer here]. You missed your scheduled session with me today at 9 A.M.. You can call me back at 123-456-7890 to schedule a different time.”

At my previous employer we worked with Medi-Cal clients alone. This enabled us to discuss the 3 consecutive no-show policy held by Medi-Cal which resulted in termination of services if they did not respond to a mailed letter reviewing the policy and their endangered client status. At my current employer I review the policy at the initial session, and the policies are posted at the receptionist.

What about Medi-Medi clients who do not have a co-pay?

Rush

I’m feeling the rush of the season, but I haven’t bothered to set up my tiny fake tree or the Nativity scene yet. There’s a push to meet productivity numbers, always, but more so during the holidays. Every week I aim to bill the state 26 hours regardless of my case load which can be as light as 10 or as high as 21. As an employee, I rely on my supervisor to keep my case load up; she’s to “court” the referral sources. This year with Christmas and New Year’s being on Thursfay, I’m working most of next week. It’ll be the first time in 4 years that I haven’t taken a day off for the winter holidays.

Yet I’m dragging. I’m chilling (literally) on a client’s front stoop, waiting for him/her to arrive. The appointment was at 4pm, it’s now 4:13pm. I need to get this case cleared up, too many loose ends, too many missed appointments. I’m the one waiting on them; I thought they needed therapy. I know one of the reasons our low SES clients are our clients is because they have difficulty functioning in society; their dis-ease impairs their ability to take perspective, to empathize, to realize others effort and know the way to respond to it.  Everyone else has made them wait hours for medical visits, weeks for funds/checks, and years for the American dream.

That said, it’s hard to wake up in the mornings because it’s a damp cold, and the last 4.5 months on a starvation budget have hit their mark. Thankfully, I received a 10% raise, considering the fact I was already functioning 6% below COLA, it’s the extra 4% which makes the difference. I continue to look for work at other agencies though.

I need to hit the hay. I have a client at school at 8am, another at 11am, 1pm and ~4pm. I suppose it sounds nice, but each client is accompanied with at least 30 minutes of street traffic, dealing with school personnel, looking for kids who are tardy/truant/absent. At least tomorrow is Friday. My plans for Saturday: sleep. Because I’m dragging. I want to put things on pause, slow things down a bit.

<rant>I saw a meme on Fb this morning that showed some people guffawing at the idea of single people being tired, compared to people with kids. You could say I don’t have kids. But I work with your kids when your family system has messed them up, when society has messed them up. You might deal with the bedwetting, but I’m the one who listens to the incest, rape, abuse, bullying, loneliness, panic attacks, flashbacks, the bingeing and purging. </rant>

Sunshine

image

I was hoping to sit by the bank of windows, their light murky and scattered by years of grime. Ceiling tiles overhead have been removed to reveal years of dry, and maybe, wet rot. A spare classroom. Used for students who need extra testing time, the afterschool program’s space to complete homework, or on Wednesdays where I unglamorously provide mental health services to kids. Here I sit across the room next to the electrical outlet to charge the phone.

The sound of students reaches me: running in the halls, shoving each other in the cafeteria line, the dull thud of soccer balls.  I try not to think about who sits alone at lunch or who is bullying to the point of being sent to the principle’s office.

I want to sit against the window pane. Instead, I stare at the little table at which I do all my work covered by my lunch bag and coffee mug, the EBP model booklet, coloring pencils, collage materials &c. The vestiges of last cling to me: dry eyes and a headache, perhaps a resurgence of a pinched nerve; more likely holiday dread. My own, but also the kids whose heads swim with financial dreams their parents can’t meet; dreams of hover boards, happiness, fully attentive parents, family trips.

I’ll hold them, but Jesus, are you holding them too?

Runneth Dry

I occasionally joke on FB that my wineskin runneth dry & I need Elijah to come fill it as he did the widow’s flour sack. This day is one of “those days” in which I wish I didn’t have more than a glass of wine left in the bottle or that I was living on a shoe-string budget and my credit card is currently on figurative ice. I’m running out of empathic things to say to kids. I’m so very tired of parents saying “you got it easier than me”, therefore the kid shouldn’t complain about: AD/HD, depression, anxiety, psychotic features, food refusal, physical/sexual assault, family trauma, etc. I want to turn to these kids and say:

“Look, your mom/dad/foster mom is a P.O.S. I can’t make that better for you. I understand how much it sucks because I’ve been through the family trauma, the family secrets, the physical and emotional abuse; the depression, anxiety and contemplated suicide more times than I care to count. Let’s figure out ways for you to cope so you don’t go crazy like I almost did.”

No one has it easier than anyone else. We all worry about food, money, paying for items.

We just worry about it for different reasons, and we cover up our messes in different ways. Robin Williams covered it with jokes, look where that got him. Lohan covers it with drugs and alcohol. You cover it with cutting scars on your arms, and I cover it with a second glass with dessert & letting the hamster roll across the floor to the sound of my sarcastic antics. However, I can’t say what I want, instead I have to “mirror” and “reflect”. Some of the suckiest things I have to say include, “we can’t solve this in an afternoon”. Yet, it’s a hell of a lot better than something a former therapist told me which is “I can’t help you with that.” I hope I never get to the day where I say I cannot help someone. I may not know the answer. I may not help them arrive at a solution that day or that month, but it can and will be overcome.

The great problem with therapy is not being able to give the wisdom you’ve gained. You’re there to help them connect the dots, and if they don’t figure this out, you’re left with the pain of knowing that they might not make the gain themselves.