Thursday, March 10, 2011

A Day in the Life: My Work

The good work circle is the exclusive work of ms kj.
Please do not use without my permission
which I will probably grant
if you ask me.

I had a tough day.

On Tuesdays and Thursdays I usually schedule eight clients. If you don't know, I am a psychotherapist these days and unlike most psychotherapists, I do what's called outreach therapy, meaning I see most of my clients not in the clinic but in their homes or communities.

I love Thursdays because I don't work on Fridays or Mondays, so once I'm done for the day, I'm free for a long weekend. (I know, lucky me.) (But don't forget, I'm old.) :^)

I never like getting up and out the door, but with few exceptions once I'm in my car I'm good to go and happy about it.

It's a varied job, driving from one neighborhood to another, to third floor apartments and public housing and substandard schools and one or two vibrant schools and drab child protection offices.
And my clients are varied: single mothers; troubled families; children from 5 to 19 often with trauma, neglect, abandonment; alcholic men; parentified teens (that means they've had to mother their parent(s) from a very early age).

Mostly always interesting and challenging. Today was tough. A recap:

9:15 She is involved with a new guy. He is sensitive to her sexual needs and that is new for her, but they have never been out and about together. She wants to go to a movie or out to dinner but he says he doesn't have time. He has been 'stopping by' for a quick hour or two once a week and it's in and out. She hasn't figured out that she can state her needs and want and hope and wait to see if he cares about that.

10:00 I see L. at school and she is not there when I arrive. She is a seventh grader who should be in 9th and really a wonderful though impulsive kid. That impulsivity will clearly get her in trouble with teachers and now boys so we are working on how to think instead of act and the fact that consequences aren't a one shot deal. I tell her that consequences have babies and every so often I ask her to state what that means. (She does it and laughs).
10: 15 I call the hospital clinician and talk about S's discharge last Friday. S is 15 and I am not comfortable saying much about her except it's a critical time. I've known S since she was 12 and back then we started with (my) three rules for success and college: no drugs, no gangs, no babies. Now at 15 the challenge is on, and it's totally crazily not easy.
10:3o I call a social worker I've come like and reluctantly tell him that I think X's placement with his father is not working. X is 7 in first grade and since his mother abandoned him and his younger sister and brother, he has lived in 4 foster homes and gone to 4 schools. Plus the current two different places with his father. In every case there has been a mother figure who has not liked him, some have been strict and mean with him. I'm recommending that he be placed in a residential program that will offer him stability and security. Not fair: there is probably no state money to fund that and no program with loving parents.
11:00 Supervision with J: She thinks like I do but she is better clinically trained and more experienced. I make up for some of that with my case management background (I can find needed resources most of the time and I know how to pull teams together). Plus I don't give up easily. And I'm a good listener. I start where people are.
J tells me I cannot see Z until her insurance is reinstated. I argue that I'm told that's been taken care of and I'm willing to eat the time if seeing her won't be covered. Also that 19 year old Z is alone in the world, and has worked hard to trust me. J doesn't budge. I have to call Z and the school and her case manager and say I can't see her until the insurance is straightened out.
J also tells me that I am behind on several pieces of paperwork and I feel abit vulnerable. I am usually on top of that and there is really no reason to complain about me, but still, she tells me I have to take care of this and I know I do.
I am back in my car and I get a text from 22 year old T. "This mite be the last visit kj cuz L ask me if I see stuff improving or working and I said no I dont see nuttn workn I told her I jus dont wana see anybody anymore." My heart sinks. I never saw this coming. I've only been seeing T for a few months but I've felt like she is benefiting and really doing better.

She is firing me...

12:00 I am able to have lunch at the Red Rose Restaurant. I love that. I order an appetizer size eggplant rotellini along with a small salad and my very favorite homemade Italian bread. I eat alone and putter at the table, happy for an unusual break.
I have seen only one client so far. Not good at all. I shoot for 8 and will be happy with 6. I plan for an average of one cancellation a day. (for both good and poor reasons: no transportation, no money for busfare, other appointments, no experience being reliable)
1:oo I was supposed to see Z at school, but instead I'm making phonecalls, returning phonecalls. I'm actually glad I have the time.
2:00 She is 48 and he is 45. They are king and queen living on second floor and running the show of a house they rent with cousins and nieces and brothers living downstairs and filling the rooms, along with their 11 year old son (also my client) and 8 year old daughter. We are working on a behavioral sticker.reward plan for their son which reinforces certain goals (no laying hands on other kids, no mean words to Mother). I teach them time out techniques today. I tell them I can help for sure but only if they can agree to a no yell, no hit household for one year. I am surprised they nod and listen as I explain: no one yells. No one. It's not that people won't get angry, but they will express that anger differently, not by yelling. J helped me come up with this. It will be a challenge. We might pull it off. I will be tickled if we do.
3:00 I sit at a kitchen table with S's guardians, a married couple. No details shared here either, but my colleague who is a therapist for S's sister and I are working together with the family piece of all this, and she is wonderful. I like her more and more every time. She is half my age and she thinks she's learning so much from me. I don't think she believes that I am learning just as much from her.
4:00 I've seen M for two plus years and now at her request her 6 year daughter is my client too. No details here either, but the whole family has major problems and everyone-- mother, father, older sister, needs to be involved if I am to help. I am shocked that father agrees. He can look pretty scary. I've seen him scare the hell out of the kids. This is going to be very interesting.
5:00 I see T and her almost 4 year old daughter in their public housing apartment. She is rethinking firing me. T is Hispanic and a single mother. She has a problem with some learning and has taken the GED several times with great effort and great disappointment. I like her. We talk, I tell her I don't agree with her stopping therapy. I more than hint that she has hurt my feelings because I am surprised she would just walk away like that. We talk about her walking away from things in general. I didn't know this about her. She and her little girl like me, are comfortable with me. We are back in business--her decision.
I'm done. I count my hours. Five hours plus a couple of 15 minute consults. I get paid by the client hour. This is lower than I normally achieve, and yet it's been a very intense day.
I like this job. Believe me, it is hard. I have learned how to do what I can, to know that I can't move the mountains that if only they could be moved. I have much more to learn and learning is good for me. It keeps me interested and interesting. And dammit, this is like a little laboratory for me. I'm dealing with poverty and class and race and children. I want and am committed to seeing what I can do. My efforts are most of the time appreciated.
Lest I leave the impression that the work I do these days is any more important than any other work, I will close with my favorite tidbit about work:
It's not WHAT you do but HOW you do it
love kj


  1. When what we do impacts others and we are around to see that impact then we know we're making a difference. It certainly does not negate the frustration that's for sure ... but it does help us to see things in perspective.

    Wouldn't we all love the strength to move mountains ... to right all the wrongs we see around us. I know I would.

    We do what we can.

    Yesterday I found out that the last three months of work (mostly mind numbingly tedious calculations and cross-checking) has all got to be done again because I was given the wrong datums.

    I laughed.

    My boss was most perplexed. Why wasn't I upset? They have been piling on the pressure because the deadlines have already passed. Every day I get at least 5- 6 calls/emails asking when I will be finished ... I am holding up the whole project blah blah blah ...

    I just told my boss how lucky it was that they found out now about the false datums and not later when all the vehicle brakes start leaking and failing!

    Sometimes perspective is the only thing that keeps us sane I guess.
    Warmest hugs from here. xx Jos

  2. I feel that way about my work here in Appalachia. It's good work. I don't mind making less money because I feel like I'm filling a need.

  3. jos, how wise you are. sometimes we won't see the difference we make but the difference will be made. three months! you are a saint, jos. and your attitude about it all is angelic!!! love to you ♥

    cs, to feel the rewards from good work is a gift we give to ourselves, yes? you have every reason to be proud. ♥

  4. Sounds like a tough, emotional roller-coaster ride of a day, kj. I know you make a huge difference in the lives of your clients. You have tenacity, grace and unbeatable combination!!

    I hope your weekend will be a good one.

  5. Kj, your work is so incredibly important. What you are doing is helping people to have a better life, and maybe for some the only person who cares.

    I can understand your being so humble, that's part of what makes you so good at what you do, and what makes you so likable. Your compassion plus your good business sense makes you the best kind of person for this job.

    I can only imagine how hard it would be not to bring most of them home with you at the end of the day. Especially those baby's. (seven is still a baby to me,sigh).

    Lori (still under tsunami warning here, and praying for Japan.)

  6. that last line is so true, dear kj, so true.

    i am exhausted just reading about your day. you give so much of yourself and your clients are lucky to have you in their lives. i know i've said this before, but it's true. you really care about each and every one of these people and it shows.

    it may not feel like much at the time, but an inch a day adds up. you do move mountains.



  7. Hi kj~ I can imagine you would be very good at this job: you have a lot of empathy, compassion, understanding, all with a sense of authority. My sister has a similar job, and I know of those ups and downs!
    Well, that day you were able to get a nice lunch in! Love

  8. You have great compassion about your work...thats why its perfect for you with all the ups and downs...xoxoxo

  9. Well the 9:15 sounds like a married man after some nookie frankly. An hour at a time? Pelease.
    L sounds like she's borderline. Hopefully your influence will help.
    Not being able to see someone because of their inability to pay is barbaric I think. Consistency with kids like this is so important. There . . one for socialised health care. If I have no money, my counsellor can still come and visit. It's all paid for by the taxpayer. Ah paperwork. Hire me. I'll do it for you.
    I can see why you like the job and why your clients like you. It's rewarding when it works, heartbreaking when it doesn't but hey, gotta take the good with the bad I guess.

  10. Honey,

    I would NEVER fire you.

    Your day makes me ache and makes me tired. It also instills awe.

    Thanks for what you do for so many.



  11. good lord KJ - I'm so glad you have those 4 days off! 5 days of this would be killing.
    I'm hoping X isn't who I think it is.

    You do good work girlfriend. I can't imagine anyone else doing this but you. You care about these people. I am truly amazed at what you do every day.
    Have a lovely weekend - OK?

  12. you are one amazing woman. one day of such a schedule and emotional ups and downs would do me in. Have a peaceful four days.

  13. You are a lucky buggar to have been born so lovely ;-)

    What you do is very important in the scheme of life.... you are helping people to help themselves.

    thank you
    much love

  14. thank you, marion. honestly i love it when i can make a difference. often, as you know, the differences are subtle and quiet. i just do what i do. just as you do ♥

    lori, thank you for your comment but you know the word i liked best in what you said: likeable! that feels like a huge compliment. it takes one to know one sf. xoxo

    amanda, yes, an inch at a time.
    you know, amanda, i have never been able to work in a job i haven't cared about. i'm very bad in that circumstance xoxo

    margaret, hello friend! some days are down and discouraging. i've learned that the goal in all this is progress, not perfection. just like life. xoxo

  15. hello sonia, good friend to many!!!

    baino, i think it may be a culture/class thing too: unreliable or irresponsible fairness to my clinic, z delayed in getting her insurance forms in on time. and i've seen her three times without coverage before i was ordered to stop!

    hahahaha, sharon! i read your comment first thing this morning and you gave me a wonderful chuckle. i would never fire you either :^) ♥

    mim, there are all these folks at my clinic who do what i do! and at other clinics! not to mention parents and teachers and SPECIAL AUNTS. (have a lovely weekend too, love you mim)

    suki, i have energy, that is true. then when i crash i crash.

    robyn, that first sentence cracked me up and touched my heart. thank you dear. thinking of you ♥

  16. So right! It's been a tough time here with our kids for the past 6 months really, with one thing and another. You sound like the perfect tonic for these clients, xx

  17. sag, i pray and hope there will be no more shakes and worries. what is going on in the world? i am just glad you and your family are safe. ♥

  18. Those "good 'uns" of us in the "care giving" field, have so much in common, whether it be humans or animals. I always want to end my day knowing I helped someone take care of their cat better; I often drag myself out of bed and wish I could return to it, til I am out of the house and driving to work. Once at work, I am happy to help and educate (though working with 20 and 30'somethings who text, facebook and play crossword puzzles instead of having a goal of learning more about their chosen field (no, to those people it's just a job) totally frustrate me.

    My therapist says the cats are my calling, yes...they are