One big death followed by many tiny ones

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I am a widow. My husband died at the end of September 2008 after almost 6 months in the hospital. Those months hold many stories about perseverance, love, advocating, healing, self-discovery, vigil, self-care, dying and death. They also hold the first chapters of my experience with grieving the loss of my soulmate; my Master Class on loss and bereavement.

One of the lessons I have learned about loss and grief is that the primary loss is followed by many smaller, often unexpected, “deaths.” In the weeks after my husband died I spent a lot of time mailing out death certificates and filling out forms. Every account that was closed or transferred into my name alone felt like I was severing another thread in the rope that had kept he and I so happily anchored in our life together. Not only was there grief but there was panic too. What would happen to me and my life if all those threads got torn and I was set totally adrift? At the time it was too much to contemplate.

Eventually the accounts got settled. I went back to graduate school. I started my internship.

And then the music stopped.

For several years my husband had subscribed to an internet radio site. Over time he had customized his two stations, which he cleverly named “hard” and “soft,” to play the perfect combination of 60s and 70s rock, surf rock, blues, and Celtic meditation music. He loved his music and I loved listening to it with him. After he died I renewed the subscription and spent many hours listening to his music and remembering. Unfortunately, this radio site was bought out and the custom stations were not transferred. In one fell-swoop I lost one of my most unique and precious connections to my husband. It was like another death, and I cried and grieved anew.

Since then I have come to accept that I will likely continue to experience “little deaths” for some time. Even now, four and a half years later, I occasionally get surprised. Today, for example, I received new checks in the mail that for the first time have only my name on them. I didn’t cry, but I did experience a wave of sadness and a tug on what’s left of that rope anchoring me to my old life.

There is so much I loved about my old life and I will be forever grateful to have had those experiences and to have shared them with such an amazing man. I also like what I’m building now, my new life. I’m helping people. I’m growing spiritually and emotionally, and I’m integrating what I’m learning into my counseling practice. I now understand dying and death, loss and grief in an intimate and personal way. As I meet counseling clients who have faced or are facing similar life challenges I will be far better prepared to help walk with them through their own process of healing and integration, and to warn them of the “little deaths” along the way.

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Relationship red flags

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RedFlags

Red flags blanket McKeldin Mall on the University of Maryland campus to bring awareness to dating violence, 2009.

In addition to being a counselor, I am also an artist. As an artist, I have learned through both personal experience and research the value of using art as a therapeutic tool. Art and craft projects tap into our inner world in a different way than talk-therapy. They also can help make issues that are inherently ephemeral more concrete. Today I thought of a project I want to try with one particular client who is learning to navigate romantic relationships. She needs to learn about Relationship Red Flags! What better way to get her involved in the discussion than to get her to come up with her own red flags and actually make a garland of flags to hang in her room?

This week we started with a discussion of some troublesome behavior from both her and her boyfriend. I asked her to tell me what Red Flags their behavior suggested to her. These are the five she came up with in her own words:

  1. When he asks me for money.
  2. Asking someone to skip school or call in sick to work when you’re not.
  3. Being really jealous and assuming bad things and then yelling instead of talking.
  4. When he wants to know where I am every minute.
  5. My friends are telling me to be careful ’cause he’s broken a lot of hearts.

All-in-all I think this is a good start. Next week we’ll add some more Red Flags to her list and start making them real. Supplies will include: poster board, markers, stickers, magazines (for words and photos) lots of red paper, red stickers, red glitter, red feathers, red rhinestones, red ribbon, and anything else I can come up with that I think will grab her attention. I’ll cut pieces of poster board to 5.5×8.5″ and let her decorate each one with a warning sign, then we’ll attache each one to the red ribbon. As we’re working (yes, I’ll make one too) we’ll talk about each flag/warning and process. This may take a couple of sessions. I’m looking forward to it!

RESOURCES:  As I was looking for a red flag image for this post I came upon The Red Flag Campaign, a public awareness campaign designed to address dating violence and promote the prevention of dating violence on college campuses. The Campaign is a project of the Virginia Sexual and Domestic Violence Action Alliance, and was created by college students, college personnel, and community victim advocates.

Another site with some very good resources about relationship violence is The Domestic Abuse Project.

This is not “light outpatient”

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My LPC-Supervisor and I have a running joke. Whenever he gives his introductory spiel to a new batch of graduate student counselors he tries to tell them that the work they will be doing at our clinic is “light outpatient,” at which point I start to laugh and cough “bull sh*t” while he blushes convincingly and proceeds to back-pedal into a more honest description of the challenging work we do. I know its really kind of stupid, but its become such a ritual that he will even come and find me just so he can say “light outpatient” in my hearing and get the expected laugh and my question, “What other fish tales have you told this group?”

For most of its 50+ years, our clinic has been an outpatient facility specializing in individual, couple, and family counseling with several psychosocial groups each week, and the work has been primarily “light,” which is to say it focused on light-to-moderate depression and anxiety, communication issues, parenting, and addiction-recovery support. The clients who had severe and/or multiple mental-health diagnoses were few and far between. Then the state started cutting funding to Human Services programs and things began to change. Our little non-profit went from serving approximately 250 clients in 2008 to serving approximately 1200 in 2012, many of whom used to receive counseling services through state-supported mental health services.

So, in January 2010, when I started my graduate practicum I was just as likely to get a “light outpatient” client as I was one who had Bipolar I, a teenager who was cutting and had Borderline traits, or a “recovering alcoholic” who still drank. Worse, a classmate who was also doing her practicum at this site ended up with a woman client who looked ok on paper, but turned out to be a person who met all the clinical criteria for Borderline Personality Disorder. Both my friend and our site supervisor did an excellent job at documenting, managing, and referring that client. There is also now a rule that the graduate-student counseling interns do not take on clients who are known to have a diagnosis of BPD.

I have learned a lot about myself since I met with my first client back in January of 2010. One of those lessons is that no matter how “light” you may think your caseload is going to be, “heavy” ones can slip in and challenge your expectations and your skills. A second lesson goes back to the semester I took Dysfunctional Psychology. I found the DSM-IV-TR and its many diagnoses fascinating, but naively thought that I probably wouldn’t have to deal with much of that. I was filled with idealism about helping troubled, but generally enlightened people reach Maslow’s state of Self-Actualization. Boy was I wrong, and the dog-eared, color-tabbed pages of my DSM-IV-TR bear witness.

Among the people I’ve had to pleasure to work with have been those who are challenged by major depressive disorder, generalized anxiety disorder, ADHD, OCD, Borderline PD, traits of Antisocial PD, Porn Addiction, domestic violence, self-injury, and suicide attempts. This is not “light outpatient,” and I’m glad. I learn something new everyday and the feedback I receive tells me that I am doing good in the world.

Namaste,
Sarah

Oh crap! I AM the therapist!

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I have been doing counseling work since January 2010 when I began my Practicum toward the end of my graduate program. I was nervous, as most of us are, to start working with my first clients. My inner dialog was full of chatter: “I don’t know enough about addictions!” and “But I’m really a Rogarian, can I even do CBT?!” and “Where did I file that article on grieving and divorce?!” But, somehow when I donned the mantle of the in-control-counselor and assumed the interested-but-not-too-pushy position in my office chair, all that chatter faded into the distant background. I was focused. I was paying attention to: facial expression, body language, tonal changes in the voice, word choice, repeated words or phrases, and the silences. I had a lot to learn (and still do), but at least I knew how to listen and reflect back to my clients what they had said in a way that caused them to reevaluate their words. All-in-all I got off to a pretty good start.

Then, a few weeks into my Practicum, I got a new client who was experiencing significant depressive symptoms and occasional suicidal ideations. She was a mess and had never attempted counseling before. She knew she wanted help, but didn’t really know how to go about it, so she spent the first three sessions basically just venting. Holding the space for her so she would feel safe and facilitated was a bit like what I imagine trying to stand your ground gracefully while a firehose is blasting you with water and full force. I hung in there and even managed to get a couple of insightful questions in when she stopped to take a breath.

What I remember most about those early sessions with this client, however, is a moment of ‘dissociation’ on my part. At one point I realized that I was listening to her story as if watching someone else who was watching her. And I remember having the thought, “Wow, this lady really needs a good therapist!” The moment I processed what I had just heard/said I snapped back into myself and into full attention on my client. My next clear thought was a somewhat frightened and  embarrassed, “Oh crap! I AM the therapist! …now what?!”

Three years later I have a much better idea about how to fill any “now what?” gaps in a session. But, I will also admit that every so often I will still hear that internal voice that says, “This guy really needs a good therapist.” Only now I’m able to immediately acknowledge that I AM a good therapist and that I and my clients will be just fine. 🙂

Namaste,
Sarah