11 posts tagged “clients”
In the midst of my shredding by one of my clients, I've been thinking a great deal. Within the context of these thoughts, one might want to note a few things. I'm really low on hours in comparison to other classmates. Some have reached the 500 hours requisite for graduation already. I'm stretching for 300. When I get new clients they'll do one of two things. They will not show up for a first time or they will come one or two times and stop coming.
Being in a learning situation gives me a propensity to evaluating my own performance and the possibilities for this shortage of hours or returning clients. I should note, not all of my clients are gone in a few sessions. I have ones that stick around for the duration, I'll get to those later.
I found myself coming up with a list of the reasons why clients don't return. Among that list contained the potentially accurate, or completely off, idea that I was doing something wrong in therapy. I know. A novel idea, but it happens. I really make an effort to be aware of conflicts within the therapy room, especially on my end, and drop them outside the door. Sometimes it doesn't work perfectly, okay, it never does, but I make an effort.
While discussing my client that reamed me, through the director, with a classmate I got reports of high praise in a session that I had with a new client that knew my classmate through a chain of people. I think the phrase was "she hit the nail on the head". I'm not sure.
It's nice to get feedback because lots of times clients won't tell you to your face if you're screwing up, repeating something you've already told them (accidentally, not intentionally, if you're completely missing the ball, or hitting it on the head. For me, I need the feedback to know what I need to change.
With this recent feedback and another conversation with another classmate I began to wonder something. Not that I fully believe it, but it could be the case in some situations...maybe I'm getting it right and that is why they don't come back.
Why is this a problem? It isn't, but it is. It isn't because I'd be happy if my clients didn't come back because I helped them and they are dealing with their "problems" differently and thinking from a new perspective. It is when you're in a grad school program and you need hours to graduate. Hey, it even may be a problem when I'm trying to earn money and I can't keep clients long enough to pay my rent.
My other clients, the ones that stay for a while, usually stay for a few reasons. 1) They really need the help and are willing to dig in and do the work (rare). 2) They really need the help, but they just want to pretend that they're there to get help so they can say they are trying when they really aren't making any effort to change. 3) They just want someone to hear their story, but not change anything. 4) They want the therapist to draw their story out of them and figure them out, where the therapist ends up doing all the work.
I have a client that likes to tell stories. The first couple times it seemed like her stories were a little relevant so I indulged her. We have since built a relationship where I can confront her in a way that's funny and inoffensive, but still gets her back on track from a tangential story. A few weeks ago we were talking and she wasn't really telling something that someone would consider a "therapeutic story", but there was information within that story. I hesitated, but I stopped her and asked a detail about the story and it opened up a huge topic that she hadn't disclosed to me and she told me later, that she hadn't planned on telling me about it. So, all I had to do was ask the question, right? I'm not sure. This client has been mostly unemotional in session and doesn't really talk about "serious" things without laughing or changing the subject. The next week, I saw her and she told me of the hours following our session and her tears and the conversations that followed. It was then that I realized, I don't care what happens in session. Whether they cry or laugh or scream at me, but the fact that what did happen in session affected her relationships after the session is what matters to me. I confronted her, in our friendly way of course, about her waiting for me to ask the right questions and speaking in code and waiting for me to decode what was going on and then ask her the right things. Having too many clients like that can be...exhausting. But I don't think it's a bad thing, necessarily. Mostly, she's not vomiting up all her past which means she's capable of having healthy boundaries and building trust instead of handing it to me immediately. To me, that shows strength.
I suppose, if I had been thinking about how much hours mattered, I could have dragged out several of my clients. I could have been nicer to them at times and not helped them deal with their stuff, but that's not what they pay me the "big bucks" for. Some people can't handle being approached directly and you have to find that out quickly or you'll never get a chance to help them. It's a hard thing, to know that about your client within the first five minutes of meeting them, but I'd rather be hard on them and know that they're willing to do the work instead of just pretend. Pretending to try is a waste of everybody's time and money.
Thursday night, the director of the program happened to wander into the control room soon after I learned the rest of my night was free. I had been trying to catch him at a time when he could read the book my brother gave me for Christmas. He didn't have his reading glasses with him, so he sat down and I read it to him.
After I finished reading the book to him we ended up talking about our case managers. This is a new thing they're doing, the first time, and I don't even remember now how we got on the topic. It ended up just being a conversation between the two of us about my own personal frustrations that I had been through a few months ago with the whole situation. He was surprised at the emotion I was expressing about it. In all, we probably spent about thirty minutes on the topic.
I went home, watched a few movies, wrote a small journal entry about the conversation, nothing too thought-provoking, and went to bed. On Friday I had to go up to the clinic to print off some shipping invoices for some items I sold on Amazon (my printer is completely non-compliant). I have to pass the director's office to get to the group room where the computers and printer is. He called me into his office and said that he had been thinking about our conversation since the previous night. This time we talked for about an hour.
He spoke of how he has been assuming certain things about what the students need here and how to teach it. He assumed we would ask for help when we needed it. He's the open-door-policy kind of guy. For me, I'm so accustomed to someone seeing me do something wrong and correcting me before I even correct myself, I expected similar treatment here. I've taken to treating supervision in that way as well. I have some classmates that will present scenarios and details about clients and ask specific questions. Me, I hand my supervisor my tape and let him watch it and see what he feels like I need to do better/different. I don't know what I'm doing wrong and I don't know what I'm doing right. I know some things work, but I couldn't tell you why in some cases.
I was pretty much the most sensitive kid in my family. I would cry if you told me I was sitting in your way when you were watching TV. Not just cry either, go upstairs, hide under the bed and bawl my eyes out, cry. I'm still pretty sensitive, but not that sensitive. Every comment was a reflection of how much someone liked, or didn't like, me. The TV thing wasn't about me being in their way, it was about the fact that I thought they didn't want me there or they'd rather watch some person they had never met (and likely never would) over me.
There were lots of times that people attempted to convince me that I was "too" sensitive. There was also a long span of time where I believed that everyone was really as sensitive as I was, but they were just better at faking it, or they had been hurt so much that they couldn't risk being that sensitive. I was in this world. This overly sensitive, everyone-thinks/feels-the-way-I-do world. I couldn't tell you how long ago it was that I realized everyone had their own world and even if they were as sensitive as I was, they didn't believe the same things as I did. I don't mean religion or spirituality, I mean, about themselves and others.
The trick in therapy is realizing that these other worlds exist and then trying to get as solid of a description of their world to find out where the damage is getting in, the unhealthy beliefs, or habits. Then, I, as the therapist, have to stand in their world and see what I would want to be different, if I were that person.
Several times a client will come in for a first session and know something is wrong, but can't find it. Or it's so overwhelming they don't know where to start. Rarely, they know exactly what the problem is, usually another person, haha. In reality, that's not the problem.
The assumption that someone will just come and ask for specific help if they need something in any situation is exactly that, an assumption.
My issue with the whole case manager situation wasn't with the actual case manager, but more the messages I was being sent from the higher ups. Nobody ever sat down and told the second years what they were supposed to do, how they were supposed to utilize their case managers, what the "rules" were, but we were expected to keep the rules and complain/seek help if it wasn't working.
Can anyone tell me how someone is supposed to complain about a situation when they have no idea of the intended goal of the scenario? I cannot very well go and complain that the case manager has been in on nearly twenty of my cases unless I know that the director was expecting 5-6 case participation. Can I?
In the end, the conversation ended up being that our director needed to change his assumptions about how things needed to be handled and the relationships between the students and professors. I'm not sure which is more interesting to me. The fact that the students thought the directors distance was intentional. The director realizing maybe the distance isn't what we need as students. Or the fact that his world was challenged by someone that is supposed to be his student.
I realized a while ago that my world isn't everyone else's world, but some people, even in their 60s are just now realizing it.
One of the drawbacks to delightful afternoon naps is even more delightful nights of being wide awake. I tried to go to bed. Okay, I tried for about an hour, but then I remembered a book that I was only about seven chapters away from finishing and I was determined to finish at least two books over the break.
I finally finished "The Birth Order Book". I really like all that birth order stuff, especially when it is mingled with Murray Bowen and his model of therapy. In any case, as one might deduce, the first half of the book kinda dragged. Sure, it's informative, but much of the book is about first, only, and last born children. None of which I am, so I was a little tired of learning more about other people. The second half got better as he spoke of parenting and how to parent combinations of various birth orders. It was definitely helpful to share with client parents.
I'm glad I'm done with it. Now I've only got...three books I have started but not finished (for pleasure), six that I have bought and not started, and a list of textbooks that lost my interest (but will be completed before graduation). I have decided that having not finished these books will function to my advantage when comprehensive exams arrive in a matter of months. The information will be more fresh on my memory because of my reading. :) I'm glad we all agree!
I have two new clients tomorrow (as well as three other sessions) so it's a packed day to say the least. Good thing it doesn't start until 1:00 or I'd be in trouble! :)
I'm a perfectionist and I know it. In most cases, this means that I won't start a project until I know I have plenty of time to complete the task. Whether it's cleaning the kitchen or fixing the antenna in my car, there's always a reason not to do it. I don't have the right tools. I have to do these other, smaller, more important things, etc. It is an avenue of my personality that I have been working on...in the tangible sense.
Something else I know about myself is that I'm a rather punctual person. Part of that is due to perfectionism. I mean, If I don't have enough time to clean my kitchen because I'm supposed to have class in half an hour, I'll just leave for class half an hour early. Sad, I know. Also, there were several occasions in the past, before I had a car, where I was late beyond my control and I hated it. This overflows into a lot of things. If I'm at church and the last teacher of the day goes over the designated time, all substance of the lesson escapes me. I'm not kidding. Sure, the teacher may think the material is worth it to use a little more time, but in reality I don't hear whatever it was that was so important.
I had a conversation with a classmate Thursday night about our session lengths. Generally a session is 50-60 minutes. I don't know how we arrived on the topic, but we were talking about lengths of our sessions. There are a few classmates who are known for their lengthy sessions. This becomes difficult when the front desk workers are supposed to be able to close up at a certain time or when another therapist has the same room assigned to them for the following hour. When this happens, everything goes crazy because, typically, the displaced therapist will take another therapist's room and it creates a domino effect. Add to the fact that the therapist who is going over also has a client waiting in the lobby...turnover just isn't happening.
I'm pretty good about keeping time. If the client is late, or I'm late, I still keep it on schedule in consideration of the other therapists and my client's schedule. The handful of times my sessions have run over it was when I was a co-therapist and had relinquished "primary therapist" status to my partner. Only once have I hit the end of the hour and felt that my clients needed to stay in it. Unfortunately, the "end" of the session was an easy way to escape a tense situation for the wife.
This conversation with my classmate made me think that I was afraid to deal with the really hard stuff. Like I can't handle it or something. Nobody wants to agree with that about themselves, especially when they are a therapist. If you can't deal with the hard stuff, what do you do in therapy?!
The almost comical part is that I have very rarely had back-to-back clients and I'm the last assigned to a room so, unless it's a busy night, I have a room all to myself. There is no reason to cut it at time in most situations.
I suppose there are other potential reasons. If I can't "finish" whatever we start in session then maybe I try not to start them due to "time constraints". Either that or I'm really not capable of dealing with the hard stuff. I have noticed that when I see a client uncomfortable with a topic I'll let them avoid it, which is totally bad for therapy. Maybe it isn't me. Maybe it's my clients and I'm trying to be too nice to them.
I suppose I'll find out next week with my clients.
It's nice to have a day off! Yesterday was pretty wild. I was up on campus to mail off some books I was selling and I stopped in the clinic to re-check my book. My 7:00 had rescheduled so all I had was an 8:00. I had a short conversation with the receptionist about my 9:00 this morning because they have a tendency to not show up. I didn't want to get up and ready and be there at 8:30 if they weren't going to show.
I can only be amused by the fact that the most-filled-slot in my book is 8:00. Not because the rest of the night is full, but it is my ONLY slot used. I have to laugh. Somehow, after returning home, my phone switched to silent mode. I didn't have anywhere to be until 8:00 and I was very close to taking a nap before then, but my consistent fears of sleeping through a session kept me from that.
About 6:30 I stood up to wake myself up and stretch my legs. I pulled my phone out of my pocket and it said I had two voicemail messages. At this point, I still hadn't noticed my phone was on silent because there are parts of my apartment where my phone will not ring. Very odd, but I assumed this to be the case with my new furniture configuration. The first was a girl from my supervision group letting me know my 7 had canceled (being helpful) and the second was the front-desk worker letting me know that an unscheduled client showed up claiming he had an appointment with an appointment card to prove it. He was there, waiting for me. Fortunately my 7 had rescheduled, I was halfway ready already, I live five minutes away, and he hadn't been waiting that long.
He's made a lot of improvement, no thanks to me I assure you, and I want to terminate, but he's not ready. My 8:00 didn't show and I was only slightly frustrated because I still got to hang out with classmates I hadn't seen in what seemed like months. I also checked my book again and learned that my 9:00 this morning had canceled. :)
Today I've been crossing things off of my list and I read To-Do List book. It's fun, but really doesn't promise what it says it will. The subtitle is "From buying milk to finding a soul mate, what our lists reveal about us." At no point in the book does it tell you what your lists say about you. Sure there are things like "because you want more control", but that doesn't really seem that...original. It seems more like a collection of voyeurisms than anything else. Granted, my expectations were probably high. I don't really know what I was expecting. I suppose some new insight into people's habit.
It's still a fun book and with each list there is a Do-It-Yourself idea for a different list which I will likely do...eventually. I like lists, what can I say? In reality, I know my point in making lists about certain things. I know that if I make a list about my goals for the future it is because I am better at remembering/reaching them when they're written down. Even the obvious ones. I know the reasons I put what I put on my "ideal mate" list. I suppose I just never saw anyone else's lists besides my own.
For the cheaper version, check out her blog. Otherwise, pick up the book.
One of my clients had me a little paranoid for a while. There is a supervisor that has been in on Tuesday nights and he watched my session with this particular client. Last week, maybe the week before, I walked into the control room and attempted to convince me that my client was "in love" with me.
I'm not sure exactly how that might make you feel, but it certainly made me a little defensive. In session you wouldn't notice. If anything, I played off of it and used it to motivate action (not that this guy wasn't already plenty motivated). Today the supervisor watched the session again and I was relieved to hear him finally admit that my client isn't in love with me.
*whew*
Turns out that he just likes that I'm smart (he believes he has a Learning Disability). Oh, and he thinks I'm seven years younger than I really am. :)
Another good session that didn't record.
Any of you kids remember last year when I worked the front desk at the clinic? Good. The kid I trained to replace me is still working there and I have a bit of a beef with him. Tuesday night I had an 8:00 session. None others. I was at my apartment minding my own business when I noticed I had a voice mail. It turns out that said student worker/first year decided there were no complications with giving out my cell phone number to MY CLIENT!!! Yeah. Needless to say, I was not thrilled.
I will admit there was a slight degree of enjoyment out of asking the Secretary (the woman that basically runs the clinic) to make sure the first years not to give out our home numbers to clients. The look on her face when she asked "who did that?" was priceless. I'm not mean. I'm just...particular about making sure mistakes aren't repeated.
In any case. Ever dramatic here. In Marital Therapy I was volunteered to role play as the wife in a marital couple. It was awkward. Mostly due to the content of the role play as well as my "spouse". It was a day full of awkwardness though.
I got a new client yesterday. New clients are typical fare these days. I get another on Thursday. Also, I'm racking in the male clients. I got my first male client last week and there are so many ethical considerations surrounding the client that only my supervisor can watch the sessions. My new client yesterday was also a man, but about twice as old. This one was interesting because there were so many characteristics about himself that he would criticize but he didn't know that we shared those characteristics. The thing is...he is who I would be in a matter of years, if I were male. This is not to say that we'll have exactly the same "issues" but more, it was a glimpse of how my life could be if I continue in some of my false conclusions about myself and other people. The difficult part is being so close to the problem.
I like to believe that all my classmates have clients that have characteristics that hit a little close to home. This presents a welcome challenge. I'm an introspect, anyone that knows me will not disagree. When there is something brought to my attention about myself, whether directly or indirectly, I often think on that topic until I have figured out a portion, if not all, of it. This introspection can serve as a strong distraction in session. There was much talk at the beginning of the program about bias and transference and how important it is to be aware of them in the session. The difficulty in this case is it's so close to home, I have no idea how to help him, so we're going to have to help each other.
In other (*excuse me for regressing to seventh grade for a moment*) FREAKIN' AWESOME news, my client that has been having anxiety attacks every day for the past five years...stopped having attacks two weeks ago following a homework assignment I gave them! That seriously made my day! I'm certainly not a master therapist, or even close to it. Most days each of us are lucky to get one thing out that we really want to say in therapy because we're working on the timing of it all (i.e. we think of something great to say after it is said). We often stop seeing clients because they just stop coming, not because we successfully "fix" them and they move on (at least at this level). It is really nice to see change and know I had a small part in it. If nothing else than being the mouthpiece for what they need to hear.
I finished
There is much to be said. :)
Tuesday was a monster of a day for me. Two weeks previous I had my eighth or ninth session with my very first client and it was the worst session ever. I realized it soon after and was awaiting our next session two weeks later to make apologies and do better. I should mention that my other clients had also dropped off the face of the earth as well so this was not just my first, but my ONLY client. After class I learned that my client canceled at which I promptly ... cried. I had been waiting and I knew that I had totally screwed it up and I had been kicking myself for two weeks and just wanted to make things right. The woman that runs the whole operation is running the desk this week because the receptionist is on vacation. I stood there and I was like... "Please give me more clients. My last one just canceled (as opposed to rescheduling) and I'm feeling like a failure as a therapist." (With tears in my eyes, no joke.) So, I go home to throw a pity party for myself and then get over it and she calls me about an hour and a half later and tells me that she's scheduled me a 5:00. I compose myself and get up there and she says that she found out afterward that it was a previous client of a second-year and the file was still open and then she told me the name. At which point, I was kicking myself for asking. This client was one of the really complicated clients that I had been watching for a while. I mean, cross-dressing, pot-smoking, threesome-having client. How was I going to help this client?! The session ended up going pretty well, but still, that's what I get for asking.
Today I had another new client. Ordered by the state. Kids taken away, spouse is a meth addict and threw a three month old baby and crushed his skull. Client doesn't see anything I can help them with. Oh yeah, spouse threatened the other kids and my client with an ax. Complicated.
I have another one next week. I'm sure it will be equally dramatic. That's what I get for asking, but it's still nice to have clients. :)
It's also family week at the drug treatment center. It's not really as eventful as the last one, probably because we got to be in an extra day last time, but it's still going well. I look forward to knee-to-knee tomorrow. Several of the guys that were here when I started have graduated (probably six of them) and it is starting to really change the dynamics of the group.
I have almost convinced myself that therapy is like life. At least my most recent session. You enter it, completely confused, having no idea what to do or how to make sense of things. Then you just ask questions to make sense of it all and the answers always come from another source. Sometimes that source is God, sometimes it is your friends, family, or society as a whole, but the "answers" come. Then by the time it's over, you still have no idea how the time flew so quickly, but it's time to go and you feel like you have so much more you could do.
My client that presented yesterday was one of those cases where I didn't know where to begin. Looking back on it, I realize that my client's issue was something close to me and my questions were an attempt to make sense of the parallel event in my own life. Put one hash mark on the selfish sessions side. One of the supervisors watched and said I did well considering the difficulty of the case, it will just be difficult without all parties involved in the room. Maybe we'll get them all in, eventually. It is so hard to help someone when they don't know what they want.
