Feeling the burn!

[Incognito]

So the joy on the job continues...lol

Got flashed at work by a client who purposefully set me up to see him naked. Yes it was intentional, and no I didn't enjoy it. (This happened a couple of days ago). Since then, in group, he announced that his "relapse trigger" is mainly cars, money, and doing "inappropriate things to women in cars." Jeez. Being the only female in a circle/group of 15 men, it was a little awkward. This man is over 60 years old and he has a picture of a penis drawn on his coffee cup. Hardly he's the first to act out in such ways. A few months ago we had a young bi-sexual gal who flashed her boobs to a house manager and she had a penchant for grabbing staff members' asses (male and female.) Had mine grabbed three times.

I suppose this kind of stuff goes with the territory? Lester Burnham...I bet you have a few interesting anecdotes to share about your days as a CD counselor?

[Lester Burnham]

Hi Tera,

Welcome to Mental Health 101- The Paperwork.

I just accepted when I was in that line of work that I would always be behind on my paperwork. And as a rule, the better the clinician, the worse they were with paperwork.

I learned what was important and what the order of importance was. First, anything they pay on (per UR review), assessments, treatment plans, updates, discharge plans and summaries, all important. Though I must say I never saw an assessment form that was forty pages in length.

My suggestion is that you do the same thing with paperwork you do with clients. That is, the best you can, letting go of the results. If you are being anal, and stressing over every detail with the paperwork, you won't hold up to the stress of the clients.

Let it go. I know, easy for me to say, but it is exactly what I did. I took the occasional write up and reprimand so as not to let the clinical work suffer.

[Incognito]

Hi Tera,

Welcome to Mental Health 101- The Paperwork.

I just accepted when I was in that line of work that I would always be behind on my paperwork. And as a rule, the better the clinician, the worse they were with paperwork.

I learned what was important and what the order of importance was. First, anything they pay on (per UR review), assessments, treatment plans, updates, discharge plans and summaries, all important. Though I must say I never saw an assessment form that was forty pages in length.

My suggestion is that you do the same thing with paperwork you do with clients. That is, the best you can, letting go of the results. If you are being anal, and stressing over every detail with the paperwork, you won't hold up to the stress of the clients.

Let it go. I know, easy for me to say, but it is exactly what I did. I took the occasional write up and reprimand so as not to let the clinical work suffer.

Thanks, LB. I knew you'd have some good advice for me.

BTW...the assessment itself is nowhere near forty pages in length. During the assessment we have to go through about ten pages of stuff with client that amounts to basic admission paperwork...patient rights, consent to treatment, conditions of admission, program rules, etc., etc. The next ten pages or so is the Target forms (also admission information but meant for statistical analysis by the state), and the next ten pages or so is the actual assessment, and then there's the master problem list, the assessment summary, and the GAF analysis. So it's really, technically about 32 pages. Still, it's enough!

I agree with you...a good clinician probably is always behind on the paperwork. And truthfully, I have been learning to speed things us a bit, but at the same time being careful not to sacrifice anything in the process. I let the chips fall where they may. So far, my boss hasn't said a word to me since the day he told me he'd like me to start getting three done in a day. He knows I'm doing my best, a good job, and if that ends up not being good enough, he can find someone else. He's a good man, a sensible one. He just hasn't had to do an assessment/intake in over twenty years and I think he's forgotten how much time it takes to do it and do it right. Luckily, I work with a few other really good counselors, and they've all concurred with me on the issue. They've said they've never done more than two in a day and we've all discussed this...in front of our boss. I think he's o.k. with the way it is now. We'll see!

Thanks everyone for your words of wisdom.

[Lester Burnham]

From the sound of things, you are not just doing assessment, but most of the admissions paperwork. That is really unusual and must be related to the economy. I never did admissions paperwork once. The assessments I did were always just drug histories and psychosocials. Two forms, make a note in the chart, oualaa! Next.

No wonder you are crunched for time. Doing three admissions and three assessments in one day is ridiculous.

[Incognito]

From the sound of things, you are not just doing assessment, but most of the admissions paperwork. That is really unusual and must be related to the economy. I never did admissions paperwork once. The assessments I did were always just drug histories and psychosocials. Two forms, make a note in the chart, oualaa! Next.

No wonder you are crunched for time. Doing three admissions and three assessments in one day is ridiculous.

Ridiculous, yes....but that doesn't include the phone calls to insurance companies (getting authorization for treatment, giving clinical review info) and facilitating the men's group counseling, and leading the art therapy groups with both the men's and the women's groups (separately.) Oh...and the lectures!

It is a lot. Maybe it won't seem so overwhelming once I get really used to all of it. This is only my second month counseling and doing assessments and intake paperwork. It's a lot to learn and my college experiences did not prepare me for the paperwork...at all.

I seem to recall you saying that you got out of this field because of burn out and/or disillusionment with the system. I'm interested to hear more about that (if you're comfortable sharing that.) I hear the turnover rate for counselors in this field is high...the average counselor stays in the field from 2 to 5 years. Any thoughts on this?

[Lester Burnham]

Ridiculous, yes....but that doesn't include the phone calls to insurance companies (getting authorization for treatment, giving clinical review info) and facilitating the men's group counseling, and leading the art therapy groups with both the men's and the women's groups (separately.) Oh...and the lectures!

It is a lot. Maybe it won't seem so overwhelming once I get really used to all of it. This is only my second month counseling and doing assessments and intake paperwork. It's a lot to learn and my college experiences did not prepare me for the paperwork...at all.

I seem to recall you saying that you got out of this field because of burn out and/or disillusionment with the system. I'm interested to hear more about that (if you're comfortable sharing that.) I hear the turnover rate for counselors in this field is high...the average counselor stays in the field from 2 to 5 years. Any thoughts on this?

<chuckle> One of the things that sent me packing was women doing men's groups. Nothing personal, but the dynamics of that are absolutely terrible.

I left for a variety of reasons. One of them was money. I started during the glory days of endless coverage and very high charges. You know, all the things good treatment is about.

I liked the work enough to stay, even after managed care came in and the money went out. But the problem was feminism. This was at the height of guruism in the field. Books by people like Norwood and Beatty were all the rage. Clinicians started setting aside their clinical judgment in favor of pop psychology that came with neat little soundbites like "Men Who Hate Women and the Women Who Love Them."

We started treating masculitnity as a pathology. As one therapist who visited my last facility to do men's groups once told me, "I love taking men's macho bullshit and shoving it down their throats."

In that time, the clients were actually paying these bitches to come in and fuck them up some more, as though they didn't already have enough problems.

I fought like hell against it and lost. As I say in my bio, "They say you can't fight city hall. Well, that is nothing compared to fighting titty hall. Not even close."

It was a pretty easy walk when I got ready to go.

The "normal" burnout was easy enough for me to manage. I did the very best I could while I was there, but at quitting time I quit giving a shit about any of them. All it took was a few funerals to clear that one up for me.

[Incognito]

<chuckle> One of the things that sent me packing was women doing men's groups. Nothing personal, but the dynamics of that are absolutely terrible.

I left for a variety of reasons. One of them was money. I started during the glory days of endless coverage and very high charges. You know, all the things good treatment is about.

I liked the work enough to stay, even after managed care came in and the money went out. But the problem was feminism. This was at the height of guruism in the field. Books by people like Norwood and Beatty were all the rage. Clinicians started setting aside their clinical judgment in favor of pop psychology that came with neat little soundbites like "Men Who Hate Women and the Women Who Love Them."

We started treating masculitnity as a pathology. As one therapist who visited my last facility to do men's groups once told me, "I love taking men's macho bullshit and shoving it down their throats."

In that time, the clients were actually paying these bitches to come in and fuck them up some more, as though they didn't already have enough problems.

I fought like hell against it and lost. As I say in my bio, "They say you can't fight city hall. Well, that is nothing compared to fighting titty hall. Not even close."

It was a pretty easy walk when I got ready to go.

The "normal" burnout was easy enough for me to manage. I did the very best I could while I was there, but at quitting time I quit giving a shit about any of them. All it took was a few funerals to clear that one up for me.

I understand your misgivings about having women running men's groups. It's not the normal way we do things where I work. We have men with men and women with women, but right now we're in an unusual state of transition (long story) and so we have a man running the women's group and I'm running the men's, but by the end of summer things will be back to normal. Luckily for the men I work with, I'm not like that woman you spoke of who said "I love to shove men's bullshit down their throats." I enjoy working with men (in fact, I've worked with women, too, and prefer working with men. I'm more at ease with them, and they do not seem to feel resistance toward me.) My style is gentle, but so far effective. I'm going to have to get over my general "attitude" about working with women, however, because soon that's what I'll be doing almost exclusively. Both genders present their own sorts of problems unique to that gender.

Our facility's counselors are cognitive-behavioral therapists. We use the Matrix system and some concepts of ACT Therapy. We don't demonize men for being men. I suppose there are places that do, and where that's the case, the men who are clients there likely don't at all benefit from the treatment they get. In fact, they could be harmed by it. I feel I'm lucky to work in a facility that is small (no more than 25-30 clients at any given time), and I like working in the intensive in-patient venue. We have close contact with our clients and we get to know them. Our facility has a good reputation, and I'm so far satisfied with the quality of care we give our clients. I understand that many facilities do not have good reputations and are far from giving their clients quality care.

[nevosopelo]

Sound like a lot? It is. So...I have six hours and ten minutes to do three assessments? LOL! So my boss says, can you do three in a day? (Right now I'm averaging two in a day- and that's really pushing it.) And I said, "sure can- but not if you want quality assessments!"

My approach is like this, "quality is never cheap and, no cutting corners at my expense". If the boss doesn't like he can lump it.

NEVO

[Percy]

Three a day, eh?

Many years ago when I was an air traffic controller w/ rank of Flt Lt (Capt) I was in an Area Radar unit - this is like a sort of theatre with tiers of radar tubes. My CO was a Wg Commander - 'Black Mac' MacIntyre - and a nasty bastard of the first water. He could only use 'stick' and no one had any respect for him; rather he was universally hated. They would follow him to the cliff and laugh as they watched him jump if given the chance!

But he did keep his hand in on the tubes an hour a day. I'll give him that. As CO he was not expected to do more than run the office and the men ragged.

Aircraft came to us on a specific frequency - to the 'Allocator' position. That chap would identify it out there wherever it was amongst the mass of traffic and then 'allocate it to a controller, who could usually manage three aircraft at a time when 'good' or four if exceptional. Two if 'new' or ratshit.

We had one chap who was a real brown-noser who was allocating one day when Black Mac was struggling with two on the screen, and the dull sod tried to hand a third to him.

Imagine. A theatre -sized room with 40-odd people all talking into headset-microphones, eyes glued to screens, and this voice booms out in slow, deliberate words, 'ARE YOU FUCKING MAD?".

It was heard by a hundred aircraft 300 miles away.

[Incognito]

Three a day, eh?

Many years ago when I was an air traffic controller w/ rank of Flt Lt (Capt) I was in an Area Radar unit - this is like a sort of theatre with tiers of radar tubes. My CO was a Wg Commander - 'Black Mac' MacIntyre - and a nasty bastard of the first water. He could only use 'stick' and no one had any respect for him; rather he was universally hated. They would follow him to the cliff and laugh as they watched him jump if given the chance!

But he did keep his hand in on the tubes an hour a day. I'll give him that. As CO he was not expected to do more than run the office and the men ragged.

Aircraft came to us on a specific frequency - to the 'Allocator' position. That chap would identify it out there wherever it was amongst the mass of traffic and then 'allocate it to a controller, who could usually manage three aircraft at a time when 'good' or four if exceptional. Two if 'new' or ratshit.

We had one chap who was a real brown-noser who was allocating one day when Black Mac was struggling with two on the screen, and the dull sod tried to hand a third to him.

Imagine. A theatre -sized room with 40-odd people all talking into headset-microphones, eyes glued to screens, and this voice booms out in slow, deliberate words, 'ARE YOU FUCKING MAD?".

It was heard by a hundred aircraft 300 miles away.

That makes me smile !

[Seattle Traditionalist]

Ridiculous, yes....but that doesn't include the phone calls to insurance companies (getting authorization for treatment, giving clinical review info) and facilitating the men's group counseling, and leading the art therapy groups with both the men's and the women's groups (separately.) Oh...and the lectures!

It is a lot. Maybe it won't seem so overwhelming once I get really used to all of it. This is only my second month counseling and doing assessments and intake paperwork. It's a lot to learn and my college experiences did not prepare me for the paperwork...at all.

I seem to recall you saying that you got out of this field because of burn out and/or disillusionment with the system. I'm interested to hear more about that (if you're comfortable sharing that.) I hear the turnover rate for counselors in this field is high...the average counselor stays in the field from 2 to 5 years. Any thoughts on this?

Tera, I realize I'm a bit belated responding to this post of yours, but I want to point out to you that counselors can work in private practice.

You are currently in an institutional setting, with 25 or 30 "in-patient" clients and some number of counselors on premises, serving these clients?

The situation you are in is certainly a good environment for you to learn and grow in, but counseling doesn't have to be the way you are experiencing it now forever.

Once your education is done you can work as a private counselor, charging individual clients a fee to talk with them for an hour. Counselors can charge clients upwards of $60 for an hour. The counselors who charge those fees may tend to have masters degrees, but still it is pretty good money.

Point being, if you get "burned out" in the kind of setting you are currently in after 5 years, you can work in a different environment that you like better.

You can even freelance, being in "private practice" with clients who dig into their own pocket to talk to you. Such a setting is probably lighter on the paperwork, the people whom you are counseling will value the experience of talking to you very highly, the hours will be flexible, and the pay per hour can be quite good.

Granted, it may take some doing to find the clients to work with, it may take a pretty good marketing effort on your part, but it can be done.

Also, from the point of view of work family balance, I imagine seeing clients in a private practice setting is almost ideal, as you are in effect self-employed and setting your own hours.

The hours may tend to be evenings and weekends, as you will be counseling mostly the employed, those who have money, but you still are in control of when you work, how many people you see, stuff like that.

Also, some counselors work part-time in an institutional setting and then work part-time on the side in a private practice kind of set-up.

So, know that you have options for the future, that you will be able to create a rewarding career for yourself, long term, if you put your mind to it.

[Incognito]

There was a young man (18) ..a patient who was crying today (at work). Not just crying but really crying. He wanted to go home. It's his third day in treatment. I wanted to put my arm around him, maybe give him a hug but I'm not allowed to do that, esp. with patients of the opposite sex. It was so hard not to. I just can't handle it when men cry. I want to comfort them and it feels unnatural not to. Talking and listening helps but I wish counselors were allowed to be more human. I understand though why there are boundaries and why they need to be kept.

[Percy]

There was a young man (18) ..a patient who was crying today (at work). Not just crying but really crying. He wanted to go home. It's his third day in treatment. I wanted to put my arm around him, maybe give him a hug but I'm not allowed to do that, esp. with patients of the opposite sex. It was so hard not to. I just can't handle it when men cry. I want to comfort them and it feels unnatural not to. Talking and listening helps but I wish counselors were allowed to be more human. I understand though why there are boundaries and why they need to be kept.

That empathy call is so hard, Tera. I recall holding a young girl for a good half-hour while she sobbed it all out. My tears flowed along with hers. But it is a judgement call.

The 'boundary rules' are there for the protection of both the counsellor and the client. It is all too eay for an emotional client to 'attach'. It is all too easy for the counsellor's 'rope' to slip from the hands and both go drifting off. The counsellor has to be a rock in a storm and keep hold of that rope. It is also far too easy to be misinterpreted. It is easily turned into 'sexual assault' accusation.

The real difficulty though is the power of touch. While most will respond positively, gratefully, there are some for whom - in that state - touch can be painful. And by that I do not mean just emotionally painful, but physically so.

Sitting quietly with a person is the safest and most usual tactic. Talking to them very quietly is good too. It isn't so much the words as the 'tone'. Sometimes - in fact often - the wrong word can make matters worse. There were many times when I would quietly pray - "Lord, give me the words". It sometimes worked !

[julie]

Honestly Tera and Percy, I can't get you 2.

But no wonder they won't allow me to be a counsellor. I could if I wanted to be (honest) but I am just not that soft.

Once I was a counsellor. There are women who are harder than me being paid the low wage and absolutely loved. Butt.... (deliberate double T)

You both deal with a world where people need tough love.

You just encourage people to be victims IMHO. I don't know how much longer I have to be in this ... but all my friends know why.

Let's get this over and done with ASAP.

[Incognito]

That empathy call is so hard, Tera. I recall holding a young girl for a good half-hour while she sobbed it all out. My tears flowed along with hers. But it is a judgement call.

The 'boundary rules' are there for the protection of both the counsellor and the client. It is all too eay for an emotional client to 'attach'. It is all too easy for the counsellor's 'rope' to slip from the hands and both go drifting off. The counsellor has to be a rock in a storm and keep hold of that rope. It is also far too easy to be misinterpreted. It is easily turned into 'sexual assault' accusation.

The real difficulty though is the power of touch. While most will respond positively, gratefully, there are some for whom - in that state - touch can be painful. And by that I do not mean just emotionally painful, but physically so.

Sitting quietly with a person is the safest and most usual tactic. Talking to them very quietly is good too. It isn't so much the words as the 'tone'. Sometimes - in fact often - the wrong word can make matters worse. There were many times when I would quietly pray - "Lord, give me the words". It sometimes worked !

Thanks Percy.

His counselor (which is someone else, not me) told me I could allow his mother to come in and see him. (First week of treatment patients aren't allowed to have visitors.) His mom did come, and that seemed to help. She told him he couldn't go home until he was done with treatment. He took that a lot better than expected and she stayed for awhile and talked to him and he seemed better after that. He did stay. He's just a kid.. younger than my own son. Heck maybe it was maternal instinct (transference) that made me want to physically comfort him but I'm glad I did not, because you're right...for some people touch can be physically painful and/or emotionally uncomfortable and for others it can be misconstrued, and I don't know him well enough to know how he might have reacted to it. You're a wise man, Percy. I love it when you talk to me like this...sharing your experiences in the field. You have so much to offer...so much I can learn from you. I really am grateful for that.