There's a kid I've been seeing for about six weeks, maybe a little longer than that. He has been on my caseload since I took over the juvenile court assignment, but I hadn't seen him because we were just waiting for him to finish the program there. Then, he relapsed. For the record, don't show up for a drug test drunk. I mean, at least he showed up, but still. Needless to say, his time was extended. As a result we decided he should check in with me and see how I might help.
I met him a while back when the previous group person was out and needed someone to sit in. He had bragged about drinking 12 Rockstars (one of those "energy" drinks) that day and I knew this kid had more than just a few hurdles to overcome. He's the classic example. Unmotivated. Depressed. Doesn't plan from one day to the next and due to his lack of planning and observation skills, he gets in trouble.
The only reason he was still in court was because his grades weren't up to par. If you're in court, everything gets watched. We talked about a lot of different things, but especially talked about breaking things into one bite at a time. Instead of looking at a huge research paper due, figure out how many sources you need to find each day until it is due. He seemed to listen as much as some of the other teens I work with, but I was hopeful that something would sink in.
A couple weeks later, I heard him stand in front of the judge and tell her that he had figured out just how much work he had to do so he could finish all the credits he was behind by graduation and he went into specifics. Now, I'm not taking full credit for this new plan, but for him to even think one week into the future is an accomplishment, even if he doesn't do the work. Personally, I would like him to be able to graduate with his class. I think he would like to as well. The trouble is the time between now and when everything is due. Will he do the work?
I think many times we have so many things to do that we overwhelm ourselves with them and end up not doing anything. I know I have that tendency at times and the only way I can finish some things is to break it down into bite-size pieces. Let's see how the weekend goes and maybe I'll have finished another bite of my project.
A few months ago, I started doing "groups" at the local elementary schools. There are two schools so we have...two groups. It was a struggle to get to do the groups during school, but the 4-6 grade school worked with me to get the group during school hours so I didn't have to worry about the kids not showing up. There are a few kids at that school who do not have friends and/or social skills. I have a few clients in the "popular" category but also a few in the socially inept category. The at-risk coordinator at the school felt that the "popular" kids would be able to teach these other kids how to be a little more socially accepted. She pulled them aside and recruited them to "help" the other, less blessed, kids. The first group was a disaster. Mostly because it was before the "popular" kids were in on the trick.
There have been ups and downs since the group started, but the "popular" kids have managed to do everything BUT help the other kids. They talk about random things. They bring toys into the group. They whine about missing recess. They make fun of the other group members. They are generally rude and obnoxious the entire time.
Today I was so close to being pushed over the edge. I was sitting in my work car in the parking lot of the school having to force myself to go inside to do the group, that is how terrible it has gotten. I reminded myself that I worked hard to get into the school and I wasn't going to skimp on my duties just because these kids parents never taught them manners or to be respectful to others. The first thing I hear from the "popular" girl is "I don't want to be here." I informed her that I didn't want to be here either, but I was there.
Group continued with moans and grunts by the two populars. I almost said something sharp, but stopped myself and then the greatest thing happened...the kid who has the most trouble socially called them on their behavior. It was so great. He talked about how there were only three people (himself and the other two socially difficult kids) in that room that were learning and that the other two were "bullies". To which the "popular" boy responded "you talk too much" and then the kid said "thank you for proving my point". Priceless.
By the time the "popular" girl told the newly vocal boy that he was "selfish", I intervened. This kid, although he does talk too much at times, was right on. The kids who have been having trouble socially were the ones being the examples to these two "popular" kids. There was nothing that the unpopular kids could learn from these two that would help them make friends or learn positive social skills. I let the "popular" girl know that what the boy had said was appropriate for him to say because he was expressing his feelings and they were accurate in regard to the manner in which these two had been treating the others as well as myself and the Aid for the school.
I don't know why it took me so long to realize that these two had absolutely nothing to teach these kids, but the other three, after the two "popular" kids left, decided unanimously that the group would be better without the "popular" kids and I am prone to agree.
In hindsight, I shouldn't have included them in the first place, but I think it was very powerful for the underdogs to finally stand up for themselves. I think it will join them together and create a bond that will allow them to practice their social skills with people who will accept them.
I will be the first to acknowledge that the following post is not really in my character, but something I started thinking about last night. I am currently on-call and enjoying the thrills of having to be at the local hospital until all hours of the night. My employer has an average-sized SPMI population (Severely Persistently Mentally Ill) as well as a group home for a limited number of these clients who are unable to live independently (or are working toward independent living). Every week, we staff these "high risk" clients. I'm familiar with the names and over time, I've met a couple of them.
My first...skepticism is...the whole SPMI thing. I suppose I don't think that people are "stuck" a certain way. Most of the clients that call in during off hours for "emergencies" are not my clients. It sometimes seems that they are taught how to live with the illness or to cope instead of understanding or changing. Yes, some "disorders" are more stuck than others, but not hopeless.
This is the part that gets a little controversial. One of the things about therapy is that you don't push your own beliefs on your clients. At no point is it appropriate to bring up God if my client is an Atheist. Personally, if I could teach faith, belief, and hope in therapy...my clients might have a little less anxiety about their futures. Last night, as I was receiving the play-by-play on an SPMI client who took four days worth of his meds I began wondering...why do we keep stopping these people? Now, I'm the last person to advocate for suicide. I have had suicide on both sides of my family and I can see how my predecessors have been affected by those choices. My moral thinking is that it is wrong and just "giving up". I think everyone deserves a chance and is worth every effort to continue to try and do better. But is my willingness to go out and prevent permanent harm just another imposition of my own beliefs?
In thinking about it, I find myself becoming a little Darwinistic in thinking that mentally unstable people create more mentally unstable people. A survival of the fittest kind of attitude. Last night, while I was in the hospital with this SPMI client, there was another SPMI client in the hospital. She was pregnant and was induced yesterday. Impregnated by yet another SPMI client and the child was being adopted by what some may call a schizophrenigenic mother. Of course, none of that is proven and still just theory, but her proof is in the pudding.
I suppose the part of me that was thinking this was the selfish, very tired, frustrated with bad parents, pregnant part that just wanted to stay in bed and sleep. Not the compassionate, hopeful, everyone deserves a chance, service-oriented person that I can be. It just seems like a cycle. Right now, very many people in the area are having crises. Their crises require the time and energy of people with fewer/no crises but because of the energy required to help these very hypervigilant people, the "normal" people can't handle life quite as well as they could the day before. So, now we create more crises due to exhaustion, irritability and overextension which means that we are less tolerating of the people who are in real crisis because the stress gets us even more insensitive to the needs of others.
Yes, keeping these people alive is the right thing to do (and not just because it's job security for us therapists), but at the same time, they are on Medicaid/Medicare and disability and some of them have committed criminal acts. Yes, everyone needs a chance, but sometimes it is difficult to find sympathy when I'm being dragged out of bed for someone who has, yet again, done something "emergent" that has nothing better to do all day than sit around and collect taxpayer money that they get because I have to be at the hospital at one in the morning.
All people are worth it, really.
All day yesterday I was thinking about something I wanted to post. This morning, as I was walking to work, I glanced up at the library and thought of my first intake/assessment and how that family is doing. The child was referred by the court and I assessed them, but they ended therapy before it was recommended.
Yesterday, unknown to me when thinking of them this morning, he beat another student to near death. It doesn't look like he'll make it.
There are several thoughts going through my mind, especially the assessment and my inability to maintain this family as clients. I will likely be spending the rest of the week at the school assisting in any way possible. Spring break will really interrupt that next week though.
And no, this is not a really bad April Fools' joke.
Everyone in town is more agitated right now. Emergencies almost all day yesterday. Kids just wired to no end. Maybe it's spring. Maybe it's something else, but it's adding to the workload. I guess that's a good thing, but I'm really looking forward to my vacation in a month. It will be much needed.
