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
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