Thank God for Running and Puppies

I have been thinking often at work what things in life the women I work with who are chemical dependent replace with drugs. When do we get our natural "high"? What are they missing or giving up for the chemical fix? I don't mean lifestyle. That's a given. I mean what are our moments of natural high that they instead strive to acheive with drugs?

I think I am in another cycle of my depression. God knows I have lived with my old friend long enough to know the disease well. Once symptoms fearful and desperate, now I recognize the lack of energy, motivation and enjoyment as like trying to run through water, slowing me down. I cuddle up with a good book more, I enjoy long hot showers, I pull out my puzzle books and buy my favorite doughnuts. I excuse myself to hunker down as long as I am fulfilling (somehow!) my other basic responsibilities.

I got to work today at 630am. I had so much to do and was getting so behind, as every waking moment at work I have a patient in my office, paperwork tends to just pile up and wait. This morning, sitting on my butterfly rug on my floor pillow with a laptop and my files and papers across the floor, I forced myself through typing and typing and typing of notes, records, documentation. Since I came in so early, I left at 4pm instead of the usual 430pm (a whole half hour-yippee!!) This meant I would get home before the sun went down. To me this means one and only one thing: I get to run around my lake before dark.

Anyone who has been depressed for any reason can tell you that depression is crippling. It overtakes you so you literally can barely do anything except curl up and wait it out, hoping you do nothing destructive. Often it gets so bad that your mind becomes paralyzed for thought and you cannot keep a single thing in your spiraling mind. Its like trying to tread water in a whirlpool. Your best saving grace, other than medications I suppose, is to have a couple coping mechanisms that you can always turn to, that always work. Of these I have just one.

When my mind is paralyzed and my body depressed, I know only to do one thing. Lace up my running shoes, flick on my ipod, and start running. Though metaphorical and healthy, the literal focusing on nothing but physical sensation and breathing calms and centers my soul. Doing this outside with the sky over my head is my zen: there is nothing like it in all this world. When I am running I have nothing in my mind but calm focus and simple purpose to keep moving forward. Working through the physical pain of my muscles and lungs cures some of the emotional ache, and the simplicity of the exercise (just breathe and keep moving) grounds and centers me. Eventually, the endorphins get pumping and my measly, tiny amounts of dopamine and seratonin get their lazy butts to work. I smile. I feel happy.

Today when I was running around my lake feeling my muscles work up a hill and straining to keep my breath even with my stride I thought, "this is the first time I have felt happy all day." It is not necessarily that my depression makes me miserable all day anymore. I have learned to cope beyond that point. However, no matter what I try, running is the only thing that brings back the "happy." Otherwise, it's just numbness, spiraling and paralysis. It is my natural high. My addiction, I suppose, for my body and mind crave it now and want nothing else for relief of the depression.

Well, almost nothing else. I have to make a little plug for my sweet sweet puppy. Though I could go on about the therapeutic benefits of animals, suffice it to say that there is something very special about never having to go through anything alone. No matter how mopey or grumpy I feel, I always have a little white bundle of fur at my side who couldn't be more thrilled in the world to be there.

Thank you, God, for my beautiful runs and my little puppy.

My Afternoon off...

Every now and again I get burnt out at work. The patients I have come in cycles- new ones at the beginning of their pregnancy with all their needs and new problems, then these same patients after delivery with the CPS involvement and custody issues. At the peaks of these two cyles, I tend to have my moments of burn-out. Having just finished a CPS/delivery wave, now I am in the new patients, new problems wave. Also, one of the six therapists left, leaving five of us to manage all the patients. My caseload is new, and it is rising.

There are various causes of exhaustion on different days. On Mondays, I have two hours of back-to-back art therapy group that I plan and run. It may sound easy, but it is its own version of chaotic managing needy and unruly patients, keeping a topic relevant to them, following rules like sedation protocols, and making sure my supplies don't disappear. Tuesday, I was feeling emotinoally exhausted; just sad. Sad for the women trying so hard to kick addiction with the odds and a terrible life history up against them. Sad from patient after patient sitting in my office crying and crying. Sad from seeing some women so far gone into their addiction that their prognisis as poor on a good day. Sad sad SAD.

Today I am a mixture of the two. After a patient, a group, clinical rounds and methadone rounds this morning, I asked my supervisor for permission to retreat home for the rest of the afternoon. To relax? Nope. To do three weeks of case notes I have fallen behind on and can't get done at the office because of constant other things to do.

SO here is my afternoon off to recalibrate and recuperate from work: millions of work case notes. SIGH. At least Zorro is here and he doesn't shoot dope, nod out, eat benzos or smoke crack. Or grass. Or snort. Or take pills. You get the idea.

The Color Test

Click'>http://www.colorquiz.com/cgi-bin/results.cgi?do=print_blog&picked1=1,5,4,2,3,0,7,6&picked2=1,5,2,4,3,7,6,0&sex=f&blog_name=Cindy">Click here to read the rest of the results.

Doing laundry

Though I had amibivalent feelings about the snow day when I woke up this morning and saw my little Accent would not make it on the snowy roads to Bayview, I ultimately decided none of my patients would make it in through the snow either and to enjoy the rare break (though pto paid for) of a snow day.

I remember in grad school writing a post in a spare moment grabbed in a coffee shop between two jobs and my classes, where I fantasized about having a day off to do laundry and be domestic. This morning as I looked around my cluttered and very lived-in apartment, with it's piles of laundry, mountains of dishes, carpet in much need of vacuuming, tables in need of dusting, bathrooms of scrubbing, and peices of my daily life scattered all around, I felt some much needed sympathy for myself and how much I give of myself at my job. Though always worrying I am never doing enough, I give every iota of emotional and cerebral energy I have every day to my women. Evienced by everything askew in my apartment, I get home and barely have the energy to wolf down some take out, pack tomorrow's lunch and crack open a book before I fall asleep.

Today with the clean white snow on the ground trapping me inside with my puppy, I took out some chicken to thaw for dinner, set some water to boil for tea and enjoyed a breakfast that wasn't just a travel mug and a granola bar on the road. I did some sketching and drawing over a liesurely breakfast, put on some sweats and began to tackle the disarray of my apartment. How liesurely and therapuetic it felt! To engage myself in something where the outcome simply reflected the energy invested: I cleaned and my apartment got cleaner. Imagine that principle simply demonstrated to the frustrated therapist! Sigh. What a reward. Though I still have chicken to marinate, and laundry to fold and put away as the tired washer and dryer finishing shaking them clean(-ish), I am so enjoying the relative predictability and reliability of my simple apartment and finally fulfilling some domestic responsibilities.

While I'm on this- I was thinking the other day how in my flurry of hard work to establish myself as an independent adult in the past few years, working several jobs at a time, taking classes, trying to license and ever move up the job ladder, I haven't had time for much else other than this thought: "Cindy, you MUST succeed!" Having come to a relatively comfortable place after all that, the next phases of my life are much on my mind. Maybe one of the biggest questions on a single woman my age's mind in this day and age is the "to work, or not to work" while having a family question. For me it is not so much a question of desire (of course I want to stay home!) but of necessity. Though I have molded my career from what I may have dreamed to become to what will come closest to that and best accomodate a family life, the question of how it will all balane out causes me angst. I'm sure any therapist, friend or mother would tell me that is a healthy thing. SIGH. The double shift...

On a lighter tangent, I often joke with my friends and my sweet boyfriend that my doggy (an eternal puppy in my mind) is my practice baby. Though I am in my mommy prime and my hormones scream "BABIES BABIES BABIES!" (not lessened by working with only pregnant women all dasy) I am luckily able to staunch much of the urge by being a puppy-mom. Go ahead, make fun, tell me he's just a dog, but I'll tell you what, he's a damn happy one, and he gives me more psychological stability and therapy than many wasted dollars and hours historically have. That said, here is my lighter tangent. A list of ways being a puppy-mom is preparing me to be a real mom:

1) As soon as I put his toys away, they are IMMEDIATELY strewn accross the apartment again, even if they are toys he hasn't touched in ages.

2) Because of number one, I am skilled at vacuuming around toys (usually)

3) I have to plan my trips ahead and find babysitters if I will be away for too long

4) He has more toys and clothes than he will ever use

5) I have the vet on speed dial

6) Sometimes he really doesn't want to do something and gives me attitude

7) I have to accept that some things about this little monster will never change

8) Whenever he wants ANYTHING, its, "Hey mom! Hey Mom! Hey Mom!!"

9) He decides to make noise RIGHT at the best part of the show or movie I'm watching

10) If he's sick or having nightmares, or needs anything, I dont sleep

11) Those little eyes get me every time

12) To him, me getting comfortable and settled on the couch is an indication that it is time to take him outside

13) I have to discipline him for things he does that I also think are kinda cute

14) I have to watch what I say around him so he doesn't get the wrong idea ("walk"? "treat"?)

15) I have to make sure he is properly sociallized with other good puppies

16) I could go on, but most importantly he is my little buddy and we love each other

Thanks for reading my ramblings on a satisfyingly restful day!

A Good Intervention

I think as a therapist most of the interventions we try fall flat- even really good ones. It’s a tricky dance of meeting the client where they are in their lives, interpreting from that where they are in a present moment, and inferring from there where they need to be directed to explore. If we ever hit those three things with precision, we still have to have it phrased and timed in a way that the patient can hear and will go with us on. Needless to say again, this rarely turns out as we so eloquently design it to. Every once and awhile, we get lucky. Usually it is not when or where you would expect. Today I had a good intervention where all those factors were in alignment, and I feel that it actually was an important and useful intervention to the patient.

I was in a family session with my patient and her significant other. They were going back and forth about the fast approaching delivery of their child. My patient was passionately trying to communicate how well she had been doing in the program (which she really has) and how committed she is to changing; how hard she was working to beat her addiction, take care of her unborn baby, and fight her mental illness. Her partner was adamantly trying to communicate he wanted to be sure she was really committed and would be there for the baby and his concerns about the new financial responsibilities. I watched them do this song and dance for about five minutes or so. Then I said,

“You two have had this discussion before, haven’t you?” They said,

“Yes, many times.” I said,

“I find usually when we get into these discussions, we do it because there is something specific we are trying to get the other person to say to us, somewhere we want the other person to meet us. We will have the same discussion over and over again, getting nowhere, until we hear what we need to.” Then I asked each one of them by their name, “What is it you need to hear from [the other]?”

They paused for a moment, then said the most profound, simple and beautiful things to each other. The heated discussion became a true cathartic moment between the couple. I know they really did all the work, but my therapist heart felt proud having had a part in facilitating that moment as each person finally heard what they so badly needed to hear from the other. The sweet thing was the other person meant it all along, never knowing how healing a simple string of words were to the other.

“I know you can do this. I believe in you. I support you.”

“I will be there for my baby. I am not telling you, I am letting you know that this is the beginning of me showing you.”

Burn-out, Compassion Fatigue and Transference

I have been struggling with my new job this past week intensely and it has taken me some time to organize my thoughts. This past week my meltdowns have had everything to do with the coworkers, and nothing to do with the patients. That's a good diagnostic tool for indicating a major internal problem for the institution, I feel.

The problem is not that my coworkers are bad people. Quite the opposite, actually. They are wonderful people and I have fell into friendship or rather professional camaraderie with them with ease. I admire them as individuals, I admire their life and professional track records. It stops there. It used to make me frustrated but now I just feel extremely angry on this point.

One coworker, working as a contractual employee (fancy wording for more skilled temp workers) complains constantly about how horrible Johns Hopkins is to work for, how tough our particular unit within Johns Hopkins is, and how it is bum-luck to be a therapist all together. I have deduced from his complaints that really he is unhappy about not having benefits from his contracting management company (transference), exhausted from the number of patients on his case load (burn-out) and running out of sympathy for a population in substance abuse he has based his professional career upon (compassion fatigue).

A second coworker, working into her third year in this unit of Johns Hopkins cannot stop putting down the program she works for as "horrible" with terrible management and as a "ceiling-job" or job you just take for awhile before jump-starting to your actual career. Deducing her statements I found she is just carrying almost twice the caseload she should (burn-out), is rewarded minimally as all therapists are, but with no training to help her deal with this (transference) and with no training on this topic either, over empathizes with her patients to the point where she can be cold and unfeeling towards them and others now (compassion fatigue).

A third coworker, finishing her first year, worked 9 years previously for Baltimore City Department of Social Services. She believes this job to be easy to get and a huge backward step in her career; a holding place for her while she goes to school to get other certifications. I don't need to break down where her horrible attitude is from. All three problems (burn-out, compassion fatigue, and transference) probably happened in her first two months at DSS.

So enter brand new employee, freshly licensed, fresh out of grad school, ecstatic to begin her professional career with Johns Hopkins with other hard-working, highly qualified professionals surrounding her. Finally the hard work, money, hard work, studying, hard work, job interviews and hard work have paid off. In the first month, other than a complete lack of training or support of any kind, she hears from her coworkers she is at a dead-end job that requires no special knowledge, certification or trainings which is basically a holding place for many and a giant step backward for her, working for the horrible agency in the worse employer, Johns Hopkins. Leave it to the new, frazzled and heartbroken employee to be a professional, trained therapist to break down the feelings communicated and deduce the actual culprits. Not Johns Hopkins, not the unit, not the management, but our good old friends burn-out, compassion fatigue and transference. Not that it helps a whole heck of a lot to know this and still be stuck in this horrible working environment.

My sister gave me some good insight to all of this. She said, and I agree, that it doesn't matter who works around you. It doesn't matter what their attitudes are, what their licensing is (or isn't) or how they try to bring you down. What matters in the end is what you came there for: to help women that are in need. Regardless of the qualifications of others, I have to have confidence that my qualifications make me better trained to be able to meet that goal and avoid the three things that so quickly decapitate a less well prepared therapist. Pride be damned!

The ironic thing is, and in school they do not teach you this, the attitudes brought on by my coworkers are transferable to me if I do not pay attention to them and deal with them in the appropriate way. Much as I believe theirs has been, my vision can be skewed to make my own self miserable. Their anger and disdain and negativity can create transference in me of my job only one short month in. Their attitude has the potential to ruin it all; burn me out and get me on board their sinking ship, and in time, I believe that it will. There are only so many times you can be hit and remain standing.

So what to do?

Why, Baltimore?

Why, Baltimore, do you sell drugs for pain and suffering? Drugs for stealing, drugs for sex, drugs for more drugs and money?

Why Baltimore, do you sell drugs to your children and have children selling your drugs?

Why, Baltimore, do you sell drugs to your pregnant women, to your women whom you abuse and get pregnant? To the babies in their addicted mothers who are born addicted?

Why, Baltimore, do you fill your streets with pain and poverty, AIDS and tragedy? Murders, suicides, overdoses and somewhere in between?

Why, Baltimore, do you foster racial hate, sex and gender hate and hate for no reason at all?

Why, Baltimore, do you fill your cold empty streets, your dirty and condemned row homes, your vacant and crumbling buildings with crackheads, addicts and the homeless?

That you helped create?

For those who were born into drugs. Those born into poverty. Those born into the streets.

For those abused by their loved ones, those abused for love. For all those lives ruined by all types of abuse.

For those that know nothing else. For those doing only what they know. For those using all they have ever experienced to stop their pain.

Find yourself out of the pain of the city.

Reach towards those that love you. Reach towards those that will always be there for you. Reach for those who gave you a chance.

Reach towards someone who has been there before. Reach for someone who has succeeded. Reach for someone clean from using, healed from hurting and working for something better.

Reach for those that want to help you. Reach for professionals who give their careers and lives to help you. Reach for programs, reach for churches, reach for caring and safe strangers.

Reach for change and don't give up. You will find yourself in a different city.