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?

Sunshine

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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?

Silence

I’m thinking about silence itself as an object/presence recently. Immediately in my reaction field is a post I was reading from another blogger here on WP.

In my work as a child and adolescent therapist to some of the poorer children (the poorest live on skid row and I don’t have the stomach to work with that population) of Los Angeles; specifically called SPA 8 (Service Provider Area 8). I’ve had the special privilege of working with different young women, all under the age of 15 years of age who have been raped, sexually assaulted, attempted sexual assault/molestation, and/or sexual harassment. Each one has told me that they considered themselves to be the only one until they confided in a friend, cousin, or aunt near to their age (under 20 years of age); then they tell me, “I told her to tell someone about what she was going through”. Can we just get this over and done with?

Ladies/Girls/Women, let’s just admit that the men in our lives want us to feel alone. They want us to be frightened and feel alone! Yet, the reality is that more women and girls are assaulted, harrassed, abused by people they know than absolute strangers.

And abuse, physical abuse is the same story and I totally want to jump in there with the kid and be like “Yeah, I know!” but I can’t. The therapy hour is totally about them, and I pull myself back inside and be all like “Yeah? Can you tell me about what makes you scared?” or “What’s that like?” I stay on the back-burner and may save my urge to blurt out for my own therapy sessions where I get triggered/reminded of getting hit on the back my head or back with shoes or slippers (and you wonder why the F I hate the color pink or her perfume or being touched at all, least of all being touched or hugged or anything by her); that evening I watched the filled Mayo jar fly by me, missing me by golly-knows-what; choosing dissociation in the closet instead of listening to the litany of Megan’s-fucked-up-as-a-daughter-because.

You know what’s also the same fucking story? (I know, a wanna-be-nun just said the F word. Pick your jaw off the floor, ‘cuz she’s heard and said so much more worse in the past). Getting harassed and bullied at work by your supervisor. I’m taking the fall because I told my supervisor’s boss that she made comments which I considered to be inappropriate. About the 3rd week of September I received information from a client’s caregiver about A/V hallucinations, and my supervisor in the course of consulting with another supervisor, stated “Oh, is this your wife?” My roommate (a co-worker) and her supervisor were in the room. As it was out of context, inappropriate, and I’m generally reserved, I didn’t say a damn thing at the moment.  However I did email my supervisor’s supervisor about her statements, explaining that I felt they were:

Hi [Supervisor’s Supervisor],

I want to make a complaint about a statement [Name redacted to protect the not-so-innocent] made to me yesterday in front of another employee & supervisor. We had gone to the back of the [Location] office to consult with [Roommate’s supervisor] about a cx [client] of mine. To this other employee (who is my roommate, [name removed]) and in front of her supervisor, [my supervisor] said, “Oh, is this your wife?”  I corrected it immediately as “No, she’s my roommate.”
Myself and my roommate felt it was inappropriate; I’m embarrassed.
I’m making a complaint as this is not the first time [the not-so-innocent] has made inappropriate comments about faith/personal issues to me; I’ve addressed them with her in the past and thought it was taken care of. I can talk more about those  with you’d like.
I write that I’m taking the fall because I’m the one getting pegged for distinct deadlines prior to the company’s established deadlines for monthly paperwork; my supervision time is being double-booked two weeks in a row and my supervisor says “oh, I messed up…no I didn’t”; she hangs up on me, she conveniently “never” receives my text messages (I can prove this via phone company) ; she gives me the clients that she’s having assigned to her (I can also prove this), which she needs to be credentialed in an evidence-based practice (one of our primary sources of funding); she does not listen to me pertaining to being able to either submit notes on-time, or completing paperwork to her superficial deadlines but not both (I have multiple witnesses). I’ll be harassed, picked on and bullied until my body collapses or she finds someone else to bully.
Yet, there’s another side to silence, where I can find peace instead of noise, calm instead of jarring harassment; can breathe without needing to calm my pinched and firing nerve[s]. For me this kind of silence is filled with incense, Gregorian Chant and sunlight filtered through stained-glass windows. Usually, I’ve just beginning to grasp this kind of silence at the end of the Mass of the Catechumens. Currently, I take a single line from the Anima Christi “Hide me in Your wounds” because it’s the only place that has been once-struck and never struck again. That blow is finished for all time, and He is righteous and reigns again. I can hide wherever I want to, but I crawl into the lance-blow, and imagine Momma Mary holds the body of her Son one last moment as in the Pieta and clasps her hand over me, not only keeping me hidden but I cannot fall out either. I sleep with a Crucifix clutched in my hands because it’s the only way I can sleep through the night without waking up every 2 hours. One of these days I’ll walk behind the closed doors of a monastery which St. Therese of the Child Jesus frequently called a prisoner; however it’s the first time I won’t be imprisoned. I’ll be able to openly declare/be myself without fear of reprimand. Nothing should slow my mother down on reprimanding me about how I’ll cause the doom-and-gloom on her marriage and am an utter disgrace more than a 7 hour drive to San Francisco. I hope I laugh when I should be silent.

Dang, I was assigned one heck of an interesting case this week. I’ll tell you all about it when I’m dead.

Mums the word & ethics code & law.

Flickering shadows

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Some weeks I drag my feet toward my late afternoon/early evening clients for several reasons (i.e. diagnosis, family negating course of treatment, complexity), and yesterday I was actually looking forward to my afternoon cases for these same reasons. I can understand trauma, depression and anxiety. I’ve got cool things to do with kids in session to help them express fears and emotions; provide information that they aren’t alone. Something sticks with each session and they slowly grow, slowly improve.

I entered a school campus today, signed in at the front desk, and the principal addressed me about “our little friend” who has gotten into trouble yet again (at least 3x/week) for disrupting other classes by playing “ding-dong ditch”. If this little guy isn’t pranking, he’s tripping, pushing, or shoving others; he’s got some fire-setting incidents under his belt, too; violating physical boundaries (examples omitted) of classmates, legal guardians, and family members. This morning was the whipped cream and cherry. It was only 10:20am.

Let’s back up to yesterday (Monday) afternoon I listen as the child’s legal guardians recount how the kid grabbed one of them by their wrists and shoved into him/her; tore at his/her clothes. All because they were out in the community and the child would have to wait until they returned home to have access to a new toy. He would have to wait at least 30 minutes, and that is what makes him angry, and dangerous.

Thank goodness we have upcoming auxiliary services being implemented because impulsivity on this level makes for more shadows and worry than I’d like. And the sprinkles on top of it all was a comment from a higher-up in management told me to consider why the child does this, when I need to address the emergent issues of caregiver safety.