Mama said, mama said...

Well alright it isn't quite that kind of day. I'm hesitating here for a minute about embedding a video that makes light of suicide on a social work blog except...I actually sometimes wish suicide could be taken out of its box of "things that can't be discussed without reaching for the batphone" because (huh this is so not at all where this entry was going to go) I believe the idea of having an escape and being fully in control of whether to go through with This Whole Thing can be a consoling thought for people who are truly unhappy.

The fact that we have to start immediately thinking about hospitalization if someone even mentions it is...understandable, because something un-undoable might be about to happen when it's mentioned. But it's a shame not to be able to let someone talk about it. I'm pretty sure some of the time something real would be gained. I'm certainly glad of my ability with certain friends in times of real misery to vent, albeit in a flippant, joking-about-going-for-the-window way, about the galling, burdensome nature of people's expectations that we will necessarily go on being.

But again, I have just perfected the art of the self-directed thread hijack. I was just going to post about it being one of those days where the idea of doing my job is really galling, I think because I was just reading at A Basement about the whole notion of not wanting to work. I've been having a lot of days lately where the only thing in my head is escape fantasies, to the point where I hardly get a thing done all day.

When I was in private supervision we would talk about this and my supervisor would say, and I always thought this was a good mix of funny and perceptive, "should we be talking about the fact that you want to be fired?" It was only helpful to an extent, of course, because I quickly acknowledged that dragging my feet at work was a self-sabotaging habit based in the...let's for now say unconscious desire not to have to work.

Unconscious is an odd concept because really I was very much aware of it, but it existed in that inconvenient space between awareness and the ability to do anything about it. I have never known exactly what bridges that gap, though the orthodox answer in analytic terms would be, I expect, "working through." And maybe this is so. Maybe if I could lie on the couch and really look at the factors present (compassion fatigue, half-assed conviction about what I do, etc) and past (oh, you know...family of origin bullshit about care->ego-strength->a lesser tendency toward repetition compulsion or something) I could do what most people seem to do, which is make a to-do list and then do it. But then maybe I idealize Most People and lots of people go through this song and dance.

For fun, I'll tell you my worst escape fantasy, worst in that it betrays a lot of consciously rejected hostility-by-way-of-fallacy toward the people I am supposed to be helping. So please do take it with a grain of salt: fantasy meaning "thing that pops into my head no matter my moral and intellectual objections."* It goes like this:

I stop doing my work. I am fired. In the fantasy this doesn't take the endless aeons it would take in my union job. I have a decadent month and then run out of money. My parents do not come to the rescue which, in real life, they would if I fell apart. I lose my house. (Fantasies do not have to be wholly about things you would ever want to happen.) I get SSI unless I mean SSDI for mental health and I move into public housing. (Ok the fantasy stays enough in the realm of the desirable that I don't have to go through the shelters and the rest of that nightmare.)

The rest is hazier as it must be. In any real detail it ceases to function as a fantasy, even with caveats ("yeah but never having to set an alarm again might outweigh not getting to spend money on the fun things I enjoy now.") But in its liminal form, with my conscious objections shelved in the corner, it gets me through a thing or two, sometimes.

Now let's see if that's enough working-through to get me through one report that's taunting me.


*Because really, I think I have a little more the filter for these things that an obsessive person has than, again, my imaginary normal happy person. I have unbidden thoughts very frequently, some of them really objectionable. I recognize them as detritus, the consequence of having the mind Freud tells me I have, which I believe I do. If I thought I had to act on my thoughts, as I understand people with crippling obsessions do, I'd be paralyzed.

(Fan)

Actually whatever. I'm in a writey mood.

So I did write once here about supervision and how much it is or isn't like therapy. I'm pretty sure we all make a few assumptions about this, in order to maintain the holding environment that we'd all like in supervision. One of these is that it's (in some loose sense) confidential. If you were to say to your supervisor that you were having trouble with a coworker, it would be reasonable to assume that your supervisor would not go straight to the coworker and say so.

Murgatroid went, I think the same day, to Director Slappy and told her apparently verbatim about my Medicaid mill comment. Slappy apparently regarded "Medicaid mill" as the worst thing you could say about a place, about her place. I think we can file this under "reaction formation" because in retrospect, the label was absolutely appropriate. Slappy and Murgatroid went into action and reviewed my chart and saw that Jake had no notes for weeks and weeks, probably the same story for Pierrot. There was a letter on my desk the next morning saying that if my charts weren't up to date in two weeks, we would need to review my employment at Fuckaway.

I went and met with Slappy. She couched everything in concern for my well being, except when she brought of the fatal phrase, le Moulin Medicaidaire. At that point she wasn't doing much to mask her anger. She explained that a Medicaid mill is a place that bills for services not provided. And then she started talking about how I should think about what might be a better work environment.

Well, I wrote the notes. It was pure fabrication, but it would have been anyway. I threw in the right phrases. Once in a while I would try to remember some actual content in the interest of some obscure correctness. It was unpleasant, not least because now I was doing it under threat of losing my job, but I finished it all up, and Murg and Slaps reviewed my charts, and that was that.

Slappy stopped talking to me. She would sit beside me in the lunch room and not look at me. I should say that for some time, she had been really collegial with me, seemed happy of my clinical interests, talked to me about Linehan and Kernberg and shit. But from the instant of l'affaire moulin until I gave my notice a few months later, I was dead to her.

Shit, meet fan.

Here is the part where my fuckup meets a fucked up system and all is fucked.

So it's maybe January and I'm losing it. I have two clients out of 25 with whom I'm doing what I thought of, coming in, as therapy. I'm actually supposed to see 25 or maybe it was 30 people a week, but it's another impossible clinic situation: you'd have to be double-booked at times to compensate for the fact that low-functioning clients don't come in when it's raining or when they're tired or when it's Tuesday, sometimes. On top of which I'm not getting assigned that many new clients.

I continue to live badly there. I feel nothing for the majority of my clients. I resent the fact that my coworkers (as mentioned, I think) are so terrified of cities that they make, and I mean they won't take no for an answer, they make me spend my own money to take LIRR home when I'm there after dark because the subway goes through Bed-Stuy and that is just terrifying. I'm too shell-shocked to do much but go to work and come home, certainly not in much of a state to make positive changes like bringing lunch to work, so I'm also spending my punchline of a salary on unhealthy food every day from one of the two places by work.

(One day I walked to the beach and picked up a bunch of sea rocks I still have. It took up more than my lunch hour, because the beach isn't right by work, but as an analog to my one friendly conversation with a coworker, it was the only time my surroundings in the place I worked felt anything but hostile.)

I continue to see Jake and a few similar kids and not now what to do with them and not see anything change for them. There was another kid named oh let's say Pierrot who is different, not nearly so hyper, but not very verbal, not sure why he's there in a way I'm never able to help with, and clearly pretty miserable. I play games with him because 1) this is considered a form of therapy in a way I guess is valid if you know way more what you're doing than I did. I was just playing games. 2) it passes the time and does not require me to pelt a kid with questions I am having trouble coming up with anyway and watch him look at me like (possible projection alert) "is this doing anything for either of us?" He's another one where the whole family is in treatment, by the way.

One day I get miserable enough that I talk to Murgatroid about it. If Murgatroid wrote treatment notes for supervision session, I guess she could write that I "ventilated affect" in this session, which is vaguely billable, I think. I don't remember feeling all that much better but I did one thing that got a result. I remembered hearing Slappy speak of other clinics as "Medicaid mills" and instinctively, in my session with Murgatroid, I use this phrase. "I don't feel like I'm doing anything here," I say. "I see these kids, we play a few games. I see the SPMI people for fifteen minutes because that's all they can tolerate and I bill a session. Sometimes it feels like I'm working in a Medicaid mill."

Affect ventilated, I guess.

That is the shit. Next: the fan.

And then! (Along came Jones, but not.)

That was sort of a stupid place to leave off with that story but oh well. It's a blog. The stakes are low.

So at this clinic, as I may have talked about in a roundabout way, there were families wherein the whole bunch of them came to therapy. As I got jaded about the place my conclusion came to be that the kids were there for free babysitting and the parents were there because that was the rule. It's a good rule, actually. I'm not saying kids never have their own problems, but I still think fondly of Dr. Russian Woman* for sometimes saying "what this kid needs is a parentectomy."

Things get done a certain way when you're in an environment of fast-paced despair. I had this kid whose real name I wish I could share because it was really funny, but I'll just call him Jake, and then one day, because Jake's brother's therapist went on maternity leave, I got to see them together for what got called "family therapy" when in fact it was pure logistics.

Attempting therapy with Jake was, of all the professional experiences in my life, the one I have been least prepared for. A therapist later would point me to an article by I think Neil Altman (who wrote The Analyst in the Inner City) called "Hyperactive Ghetto Child." Provocative title, but I remember the article as a good one though the content now is gone from my head. Anyway it was basically about Jake and his kind: uncontainable, seemingly uknowable little balls of id that bounce around your office. Jake would try to play with my computer, hide under my desk (leading to me freaking the fuck out that he was going to hit his head and my career would be over) and ask me, with respect to every object in my office "I can have this?"

I had no idea in the world how to connect with him on any level. I tried being blandly nice. I tried being blandly firm. The time he got under my desk I actually yelled at him because I had lost any sense of what to do. Analytic sorts might look at this as him producing in me the kind of reaction he was used to from others. I tentatively buy that.

Despite the fact that Murgatroid had shown no interest in discussing anything but paperwork, I broke down and asked her: what the hell do I do? She said: why don't you take him out of the office, try a different environment. There was this incredibly sad room full of cheap, mostly broken toys, and I took Jake there. It's hard to know whether this was terrible advice in terms of eliminating what little holding environment we had established, or just didn't work out. But it was a disaster. The Chamber of Derelict Toys had some kind of pipes in the middle, and not long into our session, Jake was climbing these. Again, visions of injury, lawsuit, careerdammerung.

I don't want to whitewash my role in the next part of the story. I got seriously, but seriously behind in Jake's notes. I had no idea what to write. For a while, at first, I tried writing really detailed notes, as analytic as I could make them. Murgatroid would say in an exasperated tone "these are really interesting, but" and then she'd tell me how they had to sound for Medicaid.

It's another thing I've kind of suppressed, but there was some pretty specific language that had to be in there that demonstrated perceptible behavioral change in each session. This is a lovely idea but it is not how therapy works. I will make that absolute statement and not hedge.

Writing my attempted riffs on Klein or Winnicott or whoever wasn't working time-wise anyway, but now it seemed like the two options were do that and cause myself a lot of stress or write formulaic lies, absolutely divorced from the actual experience, making both sides of the equation false: 1) I had no idea what I was doing with Jake and nobody seemed about to throw me a clue. 2) I had to discard what little content I could scrape out of telling Jake for the thousandth time that he couldn't have the plastic clock on my desk and imagine some change we had made in his life.

This imaginary change would somehow improve his life with his foster parents, who didn't seem to have any particular feelings about him, good or bad. This imaginary change would somehow improve his life in a rough, neglected school in a neighborhood of no political importance. This imaginary change would somehow mitigate the disconnect between his career goals (I am fairly sure I never saw a male child out there who didn't think he was goign to be a professional basketball player) and his numbingly bleak options.

You can imagine how writing this kind of galling fiction did not engage me. What you may not be able to imagine, if you are a functional person who goes through the day doing what needs to be done, is that I just stopped writing his notes. This is called acting out. I knew perfectly well you can't do this, because audits happen, and the auditors are no friend to anyone**, and a blank chart can be a real disaster for a clinic.

The next chapter is about the shit hitting the fan.

*There were two people who fit this description, and then Dr. Russian Man who was a bit blustery and not of great interest to me. I was kind of fond of both Drs. Russian Woman though the social heirarchy of the workplace meant neither was someone I really connected with. Also they were older, married people. But I'd have liked to have lunch some day with Dr. Russian Woman II because she was smart and sane and didn't seem to be a part of the air of disfunction that pervaded the Fuckaway Center.

**I guess if you're teabaggy you could say they're a friend to the taxpayer. To think this, though, you pretty much have to start from a position of paranoia about social services as a plot to steal everyone's money.

S'more

For reasons not worth going into, I just had to call good old Murgatroid, so that story is on the top of the mental stack again. I should say she was rather sweet, for what it's worth.

What I thought of immediately when I was talking to her was the one moment of connection I can remember having with anyone at that place. It was totally superficial, but it stuck out because basically I was either collaboratively complaining with the other people who hated the place (which doesn't nourish the soul) or just failing utterly to connect with anyone. Like there was this woman who had just had a kid named I think MiKayla or whatever the approved name that year was, and she would do things like write thank you notes to the office in sort of proto LOLcat baby-speak, first-person for baby gifts, and we just looked at each other like "are you nuts?" a lot.

Anyway the one moment of connection involves a confession: I have enjoyed certain novels of Dan Brown. Worst prose stylist in history, but good with the suspense! Shamefully, I have read most of what I guess I will go ahead and call his oeuvre. Oh, so wait, though. Uninteresting back story: there was this guy who worked as a clinician and supervisor at the Clinic at Fuckaway, and his mother worked in some accounting position or something like. We'll call them George and Estelle because Estelle had the accent and more or less the exact demeanor* of Estelle from Seinfeld and George was accordingly a pretty miserable guy like his televisionary counterpart.
Sad/diagnostic fact: it took a lot of effort to remember their actual names, and the last name isn't coming.

This story is getting really "and then I found five dollars" really fast so I'll end it as quickly as possible and get on with what I meant to write about. So I'm in the lunch room and people are talking about Dan Brown and George and I are the only ones who have read, uh, which one is it...all same book...Angels and Demons? And we're trying to talk about the ending and people are freaking out at us on grounds of "no spoilers!" and we end up doing this rather elaborate intepretive dance to express which part we just found beyond the pale in terms of willing suspension of disbelief and we laughed together and it was maybe the single instance of friend-like interaction I experienced on the Fuckaway Peninsula.

The other thing about the lunch room is that people discussed clients there. In front of support staff, who jumped into the conversation. In front of anyone who was around. I was stunned, because my second year placement had been a setting where people were stright about those boundaries. And Aunt Slappy, if you have been following this story, would jump right in a lot and say "oh I know her for years now. That one is real trash, a real piece of garbage." This was the tone of things.

I mention this because I think it's one of the things that led up to my real shellshock experience there. Which I guess I'll make another entry, because this is already a snack and it probably need not be a meal.

*You brought 'er...

We Have Met the Enemy and you know the rest

Our union rep was here today. Offhand I would say she has a mild personality disorder and some cognitive weirdness. Technically speaking. Loose association, pressured speech, and just that ineffable quality that makes me turn around and walk in the other direction if the situation allows. Wonderful.

Expectations, Raised and Lowered

Today I had to tell a client "it's going to take me slightly longer to find you a program, because you don't have Medicaid." The problem wasn't that he had no insurance. The problem was that he had private insurance, otherwise known as the thing most of my clients would love to have but may or may not ever. It occurred to me that in the isolated instances where I had to refer someone with private insurance for treatment, the Medicaid clinics kind of shrugged at me. Picture a clinic shrugging. Or don't.

This was part of a larger interaction that gave me pause. I got this case as an "ER"--this is to say, the attorney wanted something to happen without the delay of referring the case. They're allowed to do this, obvs. It's a pain in the ass but only the way paying taxes is--it's a drag but you have to do it. It was an especial pain in the ass today because I have some slightly-more-vicious-than-usual twenty-four-to-please-baby-jesus-forty-eight-hour malaise. I feel, as they say in certain parts of the south, as if I'd been shot at and missed, shit at and hit.

So, nothing special except he needs to start treatment post haste so the judge will say "what a sweet angel--he's suffered enough already" instead of "why should I give a middle class white guy a break?" I don't know if judges start from there, but it wouldn't be unreasonable to. Look at prison demographics and get back to me when you're done repeatedly shooting yourself. Now of course they should get the same baseline of consideration anyone else gets, but it's hard not to notice they've had a head start already. If you buy a bunch of cocaine and have a lot of advantages including your skin color, you are counting on these advantages. It's understandable, but it might factor in to the sympathy you get.

The thing that went on that I wanted to sit with for a minute is this: I talked to this guy very differently than my other clients. I made assumptions about what he knows and what he is able to do without my prodding or assistance. I took a different tone, some of which is just because the stance I take with someone clearly from a very different background from mine is to remove a certain assumption of rapport. I do this with kids, too, which makes me feel a little less like it is my class bullshit. But it can be a number of things at once.

It's one of the real fears you have in school, or I did anyway. How is anyone going to take me seriously when, by my clothes and my job and probably my snooty way of pronouncing things*, it is probably clear I have not had things too bad. I will never truly get the stories that are told to me, and I know it, and the people telling them know it. What you figure out is that most people get past this because there's not much to be gained by dwelling on it. Anyway.

What I can't shake is that it felt like I was flipping a switch between "talk down to" and "don't talk down to." My explanation of what I do was different, something of a mess both because I feel like doom and because I was recalibrating as I talked. I think this is the crux of it, actually. There is a fairly standard spiel I give, and it is very possibly a bit condescending in a way that I don't notice when I'm talking to a 15-year-old or someone who made it to 9th grade. There is native-language stuff in there too, and from there, race stuff, which is the thing that makes for least comfortable introspection. I should notice. This is a little bit of a resolution.

Maybe I'll talk more about my spiel and its assumptions later on, if it seems like there's much to say.

*Truish story: when I was growing up in Southlandia, my friend M and I went stomping around someone's farm in the delightfully dewy very tall grass. Some cops were not into this (charge: trespassing? unauthorized grass stomping?) and questioned us a little and after I had said just a few words one of them said to me "where are you from, anyway? Liverpool?"