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dcnativegal · 5 years

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In which I change jobs and listen to the people of Lakeview

Back in August, (it’s now early March, 2019) my boss called me up in my office in Christmas Valley and asked if I’d consider moving my work to Lakeview and joining the Lake District Clinics’ staff as a therapist. I pretty much said, you bet, when do I start? It’s not that I haven’t loved the people I work with as colleagues and as clients in Christmas Valley. It’s more that I have spent most of my 30+ years as a social worker basically embedded in medical teams, working on the psychological and practical issues that come up for people who are medically ill. The prospect of going back into a busy clinic at a bustling, though tiny, hospital, excited me. And so it was that I said goodbye to my clients, and to my work buddies Hayley, Jama, and Geri, and started driving south instead of north from Paisley, in late September.

It's now been 5 months, and the metaphor I use is that we are building this airplane while flying the thing, since this is the first time this hospital has had such a role: ‘Behavioral Health Consultant.’

Behavioral Health Consultants are culturally competent* generalists who provide treatment for a wide variety of mental health, psychosocial, motivational, and medical concerns, including management of anxiety, depression, substance abuse, smoking cessation, sleep hygiene, and diabetes among others. (definition brought to you by https://en.wikipedia.org/wiki/Primary_Care_Behavioral_health)

*The better term than culturally competent is ‘culturally agile’, but the idea is the same: to be agile is to establish rapport with anybody, including people from the ethnicity called “white” and the culture of “taciturn cowboy.”

The new job has an aspiration: “Primary Care/Behavioral Health Integration” whereby “mental health” is not taken care of in some other place, complete with another building, parking lot, and stigma (because when the town’s population is 2,300, everyone knows your rig.) If a patient comes to their primary care person for high blood pressure, or a miscarriage, or very high blood sugars, and the primary care person hears that your marriage is disintegrating, or you have nightmares, or your child killed her/himself, then there’s an immediate referral to me. If I’m busy with another patient, a referral gets made electronically, a receptionist calls this person, and boom, they are on my schedule. If I’m not busy, I’m brought in to meet them right then. Perhaps this person is crying, and I sit and listen, and maybe it’s just a bad day, or a sad anniversary, and what I do is provide compassionate listening. And my card. Perhaps we start a conversation and they schedule for a longer session because they hadn’t figured on being gone from work so long. See you soon, I say.

Behavioral Health Integration is new to much of the country, and yet it makes so much sense. Mind and body are connected. The trauma someone experienced as a child contributes to both his anxiety now and his high blood pressure. Her alcoholism might be worsened by her spouse’s infidelity: however, her liver is for sure. Let’s get this addressed, mind/body/spirit. Teamwork, people.

There are two other populations I get referrals to see. The folks who are taking an addictive substance that really isn’t good for them long term: either benzodiazepines like valium, or opioids.

The second group are the frequent flyers: folks who use the emergency department a great deal. There’s a team of people who try to help them. Are they anxious? Anxiety causes a lot of emergency department visits. So does a life that is very disorganized. Who can keep track of the day of the week, let alone an appointment in a clinic? There’s a meeting of people from many disciplines who meet weekly to brainstorm about how to create a supportive, educational web of services so that this person doesn’t use the most expensive health care resource available, (the emergency department) or bounce back into the hospital because being at home wasn’t safe.

I’ve had some interesting encounters. I meet people who are so much pain that they rock back and forth while they talk to me. I hear about a family where every single member has a serious disability but only one member will come in to talk to me. I finally went out with them to meet another relative waiting in the car and basically said, Hi, I don’t bite, come in to see me sometime, okay? It took 3 months but it worked.

A child came and sat at my table, proceeding to play with my wooden robots, then the magnet marble sculpture thing, and then color a mandala. All the while, a biological parent tells the story of their predicament, and the child corrects and fills in, holding the memory of all that has happened to this family. I find myself wishing multiple times a day, “if only the adults would adult.”

Another child is having panic attacks. Perhaps the addicted parent and the chaos at home are factors? You decide.

There is a funny thing that happens as I work in the arena of mental health while in a small town, and it will keep on happening. I assess one member of a social network, which may or may not be related to one or four of my other clients. The jigsaw puzzle of the situation becomes clearer and more recognizable while I listen to the stories. I can’t reveal that I already heard that story from someone else, with significantly different plot points and antagonists. I simply make note. Later that same day, the client has become the guy or gal behind a counter: well hello! And then I see the client’s mother in town: she peered at me through narrowed eyes, told me she was glad to know who was talking to her son. Sounded like I passed muster.

pass muster

be accepted as adequate or satisfactory.

synonyms:

be good enough, come up to standard, come up to scratch, measure up, be acceptable/adequate, be sufficient, fill/fit the bill, do, qualify

I met with a rather desperate patient, in chronic pain, and super pissed off about everything. That patient died unexpectedly and sadly a few days later. On the same day I learned of this death, two of my other clients came in, separately, and cried about the sudden loss of this person. Used up all of my tissues. We are part of a tightly woven web.

And I can’t talk about any of it except to clinical supervisors or my therapist. Which is fine. Thank goodness I can take notes. My brain gets very full.

I no longer have the Roarks, Hayley the amazing therapist and her husband Tom the amazing police deputy, who could give me the back story and the full list of felonies for most of North County. I exaggerate only slightly. I do get perspective at the team meetings where we talk about the frequent flyers: everyone has a piece of the patient’s history. And everyone knows everyone else, and what they did last summer. I will never have that deep knowledge of this community that natives of Lake County do. There is a chaplain who seems to have the same deep, back stories of everyone in Lakeview. The primary care providers know a great deal, too. Perhaps my fresh perspective has a benefit: at least three clients have told me they are glad I’m not from here. They have a chance, a clean slate, instead of me having assumptions based on last name, what side of town they live on, etc. And I try so hard not to judge. I sit and listen, always humbled and amazed at the stories that are shared.

I can’t share specifics, but I certainly see themes.

Let’s talk for a minute about step families. There are an awful lot of step families and second and third marriages and many times, live-in sweeties who act like step parents, all of which is very confusing to children. There are a couple of rules that I thought everyone knew, but apparently not. Such as:

· Do not, under any circumstances, tell a child, ‘you are so much like your Mom/Dad’ if those qualities you are calling out are negative. Please, please. You are not getting back at the miscreant, who is a conniving/cheating/meth-dealing/flake. You are hurting your child. (See, self-fulfilling prophecy. See, shitty legacy.) STOP IT.

· Grownups need to do the adulting. Children are not go-betweens. Period, end of sentence. Also, children best not play one parent against another: the only way to make sure THAT isn’t happening is to …

· Co-parent. If your kid has left your home to live with grandma, or step-father, or aunt, whomever, guess what? You are now co-parenting with your mother or step-father or sibling. You are coordinating school meetings with teachers, immunizations, and team schedules. You are consulting with the ‘other parent’ on whether the kid gets a smart phone, or can date, and whether they need condoms. Circle the wagons and parent the kid, whatever the old painful history. For the kids’ sake.

Right?

How about grief. People feel grief about all kinds of things, and especially the loss of other people. One grief hooks up with all the other losses, and sometimes, the heart just breaks and the mind stops and the tears flow. My all-time favorite quote about grief is this one:

People, usually, the conscientious ones, have very high expectations of themselves. They will plod on, and keep it all up, until the tears overflow, and they are horrified when they cry at work. Perhaps the long-dead person was the only one who ever stood by them, which explains why the ‘little’ loss that happened just the other day flowed into this biggest loss, and they are overcome.

I do some ‘grief education’. That it comes in waves. That patience with oneself is critical, and kind: if you can’t stop crying, then you need to cry, and go ahead, take the rest of the day off. You are not a slacker, or a malingerer. You are giving your mind and aching heart a break, and that is a healthy thing to do. We talk about options like writing a letter to the one you miss, so that you can tell them what you’ve been wanting to share. Who knows, maybe they are listening. Whatever the metaphysics of the matter, they exist in your experience. In psychoanalytic terms, that’s called an “introject.” Write freely, as if they will hear your words.

Or maybe write a song, or draw a picture, in their memory, in their honor. What would they have told you to do, if they knew they were about to leave this mortal coil? Go forth and find another lover? Get back to playing that guitar and never mind how bad it sounds at first? Go dancing. Go bowling. Have a beer, or stay sober, in my name.

And know that you cannot push through grief, there is no shortcut:

It is an alteration of self that we would not choose, and it is excruciating. We are altered without anesthetic. I’m sorry. I have been so altered.

Let’s talk about social isolation. I found this quote in the New York Times and had it made into a canvas hanging in my office: (via EasyCanvasPrints.com)

Most of the clients I see are deeply disconnected from people, especially the men. Maybe there is a wife who connects him to the rest of the family, or a mother. But no one else. He doesn’t speak to his children. He’s estranged from a sister or a brother. No cousins, lost track of them. Don’t care to reconnect. Old pain, betrayals, lots of good reasons to stay mad. Except for the loneliness.

I encourage clients to call up an old friend and say, I was thinking about you, what the heck, I thought I’d call, tell me what’s going on, if this is a good time. Once the person gets over their shock, the content of what your old co-worker/ cousin/ younger sister tells you is refreshing. At least it isn’t the same old thoughts going around like a trapped gerbil in your mind. And then you’ve strengthened an old bond. Why not? Doesn’t cost anything.

I know it feels awkward. I called up my first cousin, out of the blue, after texting her to make sure I still had the right number, and in my text, I said, could you chat? She called me right away thinking something was wrong. We hadn’t spoken on the phone since I moved to Paisley. I didn’t mean to scare her. But I didn’t do our usual calendar/Christmas thing this year, and she’s my first cousin. We’re friends on Facebook, but we don’t share the whole truth on Facebook. We were candid. Life is imperfect. And I renewed that bond with this bright, hardworking woman with whom I share DNA.

I also hand-wrote several letters to old friends. I got lovely texts or emails back saying a letter will come in reply but give them time. I’m totally fine with that. And even if nothing comes back, I sent forth a bit of love, and story, to distract them from their mind-gerbils. There was a woman at St. Stephen’s, whom I got to know when I worked as the Parish Secretary and she was a volunteer. She would send a lovely note or postcard to someone and stamp it with “GUILT FREE MAIL.” How wonderful is that. Edith Eder, you were a gift to the world. She would wait to give baby blankets to newborns, and I think she waited because she’d had a stillbirth at one time, and knew the pain of having no baby for all the cute clothes and rattles that had been gifted.

*****

Ultimately, for the anxious and depressed, I hope I can convey some information, some strategies and tricks, a wee tincture of wisdom that they can hold onto, when they hit a bad patch. I have my own therapist, in Bend, 3 hours away, whom I see once a month. I take my anti-depressant dutifully and gratefully. I approach my very own bad patches and slip and fall, like I did over thanksgiving. I try to spot the bad patches, like drivers look for black ice this time of year, but sometimes the slipping can’t be helped. And kerplunk, we are in the ditch and need a tow. Best to minimize the damage, do what needs to be done and chalk it up to ‘When Bad Things Happen to Good People’, which is the book I recommend most to clients.

There’s the awesome quotation by Anais Nin about the blossom:

I see entering into psychotherapy this way: it is a risk, because the familiar misery feels safer, at first, than the bright new possibilities of change, which are scary, but then, occasionally, breathtakingly glorious. And in any case, patience is required. With ourselves. Again, Anais Nin, who is an incest survivor by the way:

Amen

#depression anxiety psychotherapy

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