thepathNY

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Should you stay or should you go?

April brings showers, visions of spring, and the beginning of the end of your field year experience. What are the benefits to staying or saying good bye? Here are some things to consider as you begin the process of winding down your field experience.

“Should I stay or should I go…” ~ The Clash

Termination
Go: While it may seem counterintuitive to begin with the end in mind, this is precisely what fieldwork students should be thinking. A large part of the learning process during the internship experience is learning how to terminate with your clients. Clients will (and should) move on. Knowing how to say goodbye and prepare them for either your departure is just as important as the very first session.

Stay: Even if you decide to stay, termination is one of those phases of treatment that is inevitable and unavoidable. Stay tuned for tips on how to terminate with clients.

New Faces, New Spaces
Go: Experience a different environment, coworkers, supervisors, client population. Building and growing your skill set is an important part of your career. You can use the end of your internship to explore a different side of yourself while practicing and enhancing your skills as a counselor.

Stay: If you decide to stay, be sure to make clear your new role as a professional. Perhaps there are new responsibilities you can add or change so that you are not continuing in the same role that you were in as an intern.

Taking Time Off
Go: If you’re graduating and completing internship concurrently, it might be a good time to take a much needed break. Processing doesn’t stop just because there’s no professor after you for that reflection journal. Taking a break allows you to process your whole experience and the experience of being a graduate. Journal, dream, meet and greet other professionals. You can still be productive in your career outside of the office.

Stay: If you decide to stay, be sure that you’re building in self-care and discuss new work schedule options with your agency.

“If I go there will be trouble…”

Staying On

They love you and they want you to stay. Congratulations! Use the “Stay” strategies above to really define yourself as a professional counselor in your new role. Seek opportunities to grow within your position. You’re in a prime position to help new interns acclimate to the fieldwork experience. Utilize your skills, share what you know, and please do not forget to schedule your first vacation!

“If I stay there will be double…”

Saying Goodbye

Remember to always give a clear ending date and remind your supervisors and colleagues at least two weeks before you end. Treat it like a job, put in your notice and make time to wrap up loose ends before you depart. Maintain the partnership once the internship comes to an end. Connect on your social media and professional networks. YOu can stay up to date with them and they with you. As you job hunt, they may even endorse some of your skills. It never hurts.


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Back to Basics

I’ve been privileged enough to have had several interesting conversations in the past few days. Strangely, they all seemed to have common threads dealing with acceptance and happiness. I ended up with a couple of questions that feel very relevant.
1) Am I accepting of my place in the present moment? and 2) Am I happy or not?
The nuances in the answers to those questions CAN be vast…but for a second I put all of that aside and gave myself the old elementary-style quiz.

happy or not

Life is undeniably more complicated than this. I’m as guilty as anyone of getting wrapped up in the nuances, the expectations, and the anxieties. I know too well the feelings of confusion, frustration, and muddled sense of self that sneaks in even while sprinting down the “path to success”. The simplicity of those questions and boiling it down to the basics helped push aside all of the “should, could, musts” that come along with this existence and helped me tap into the most primary feelings and motivations. In asking myself these questions and allowing myself to sit with the answer without analysis or expectation, things became just a little bit clearer in the moment.

Isn’t that what most of us strive for anyway? A little slice of clarity and simplicity one moment at a time?

accept

Fall Reboot @ Acadia National Park

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Fall is not my favorite season.  I dread the upcoming cold and long for more days of summer heat, green grass, and balmy evenings.  But, this fall, my partner and I decided to kick off the season with a trip to Maine.  A chance to reconnect with nature, with ourselves, and bid a sweet farewell to the last days of summer.  I’m more of a beach-goer and would happily spend each and every day counting sand grains and listening to the waves roll in.  But, every once and a while, there’s a place so beautiful that it almost makes me think I could opt for a woodsy retreat as a viable beach alternative.  This was my experience at Acadia National Park.  The park is full of trails for hikers/ climbers or all levels and there’s enough beautiful landscape to keep everyone happy.  We had a chance to hike the Beehive Trail (a fun trail but not for the vertigo-afflicted) and take in the most beautiful views from the top.

What do you do to welcome the fall and reboot?

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“Who are you?”

As a neophyte counselor there are still a slew of issues and topics that I’m getting used to.  I was lucky enough to continue my work with ex-offenders during which I’ve grown more comfortable dealing with issues of probation, prison experiences, blush-worthy sex topics, and a gamut of experiences that pull on the full range of emotions.  Still,  it’s the personal questions directed towards me that make me freeze up.

“Do you want kids?”

“Why aren’t you married?”

“Do you believe in God?”

While I have answers and explanations for each of those questions that I would normally be happy to spout over a drink at the bar, in the counseling chair I feel just like…

deer in headlights

While there are a number of reasons they might be asking those questions, I realize that sometimes it’s just a humanizing method.  These questions are just leading to the bigger question clients might have: “Who are you?”

Who Are You – Alice in Wonderland

How much of who I am is important in session and I still struggle with determining when it might be appropriate to answer any questions the client might have; disclosure isn’t always cut and dry.

I try to determine whether disclosure would have any therapeutic usefulness.  Does it matter if I pray to one God, pray to several gods, don’t pray at all?   What value does the answer have and if it does have value, what is the best way to express it and where do we go from there?   Is it unreasonable that some would want to know more?  To feel less like they’re coming in for therapy and more like they’re meeting with someone they know?  It’s tricky ground this therapeutic relationship stuff and the rules around disclosure do not seem to be “one size fits all.”

I tend to err on the side of caution, not giving too much, volunteering virtually nothing, and when I do answer, it may be the bare minimum.  Would it be so bad to share a real answer to any of their questions?  The answer for me is, “yes, sometimes.”   The balance of private and professional feels precarious at times, disingenuous at others.  I’ve seen the damage that it can do to have a hard-fast rule that removes the person from the experience.  The “It’s Not About Me, It’s About You,” approach.  I’ve also seen what happens to counselors that cannot seem to hold their tongue – their usefulness quickly comes into question.  From personal experience, I’ve enjoyed the bond that can take place when a therapist discloses; I know that it is a decision they made to do so and that when made correctly it can add something invaluable to the therapeutic experience.  Maintaining boundaries is important to me and in the profession.  Disclosure is part of that, but learning how to navigate the nuances is still a work in progress.

How to others navigate self-disclosures?

“Damn, and just when I was starting to get it.”  ~Edgar Degas

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Befuddlement #1 and a Chart: Offenders, Employment & Compliance

There’s something that continues to befuddle me in my still very small clinical world.  I work primarily with individuals that have been convicted of having committed a sexual offense and I have many questions about why things are the way they are.  The chart below shows a piece of my befuddlement related to offenders, employment, and compliance with mandated treatment.

Befuddlement #1
Roads to Non-Compliance

There are quite a few factors I’m leaving out, of course.  Generally speaking, I find it difficult to understand how we can demand compliance for treatment that they have to pay for, at the same time making it incredibly difficult for those with a felony – particularly those with a felony in for a sexual offense – to find gainful employment that would allow them to remain in compliance.  There are many more roads leading to non-compliance which seems counter-productive to…well…everything.  This crude chart doesn’t even begin to address the issues of counselor burn-out and lack of support for agencies that do this type of work.  What exactly is the end-goal I wonder?  Is it really to successfully reintegrate offenders back into communities and guide them towards being pro-social and productive members of society?  The more I see this patterns in the system that lead away from this end-goal and lean towards  failure, the deeper my befuddlement.

In my mind, a more useful chart might be something like this:

Employment & Empowerment

I’m interested in how other countries work with their offenders and treatment mandated populations on issues of reintegration. Next stop…Canada.

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Was it something I said?

Sometimes, interacting with clients feels a little like speed-dating. We meet, we chat for a bit, and suddenly I find myself wondering and worrying about whether or not they’ll call me again. Did they find our session helpful enough for round two? Am I the type of counselor they can see themselves with?

After a first meeting or particularly difficult session, a client cancellation or no-show prompts me to rewind back through the session in slow motion, searching for clues that might answer that persistent nagging question: “Was it something I said?”

I’m embarrassed that a missed session can so quickly bring down my carefully constructed fort of self-confidence.   The cancellation/ no-show kicks up those still too-fresh grad school feelings of self-doubt and uncertainty.  At best, I feel a little rejected.  At worst, I fear I’ve scared them away from counseling altogether.

I had to face this recently when Calm Client missed not one, but two sessions in a row.  Complete no-shows.  No call, no text, no pigeon carrying a calligraphic notice.  So, I did the normal thing and placed a phone call.  No answering machine and no client.  Then I did the abnormal thing and conjured up the last session (and the one before that) for a mental re-run.  By the time I was done  – none of it yielding any clues – the second week had come and again, a no-show.  Well, I thought, I’ve really done it now.  I called again but this time the number was no longer in service. I must have scared Calm Client right out of the state!

The following week, I was shocked to see Calm Client was waiting for me, a full 15 min before the scheduled session. The wave of relief that Calm Client was a) physically fine and b) present was overwhelming.  I felt greedy to know what had caused the no-shows and I prayed it had nothing to do with me.  The explanation was one of the best I could have ever hoped to hear.  Calm Client had landed a new job and the change in schedule caused the missed sessions.  Calm Client meant to call, but had not.  And my second call attempt failed due to a change in phone service.  The words from Carly’s song came to mind, “You’re so vain…” and yes, I did think that the no-show was about me. It wasn’t.

My take home lessons:

1. The cancellation/ no-show might not be about you.

2. Self-confidence is still a weak spot. As a new professional, it’s easy to fall into the mindset that perhaps you did something wrong or that you’re not very good.  Keep building that brick house of self-confidence.

3. The cancellation might indeed be because of you…and now how do you prevent those negative feelings from causing you to run screaming from the profession?

While I work on the internal aspect of cancellations, I’m trying to take a proactive approach to managing cancellations.

Client Responsibility – When I meet with clients for the first time I stress the importance of calling in at least 24 hrs before the session if they cannot make it.  Not only does it put some of the responsibility on the client but it serves as a way for me to check in on the client. I’m far less likely to feel anxious and get lost in the world of self-doubt if I can hear the client’s voice (their tone can tell you quite a bit) and provide a positive statement like: “I’m sorry we will not meet today but I look forward to seeing you next week.”

Assigning Homework – I don’t do this in every session, but sometimes a well-timed homework assignment can give clients that extra push to make it next week.  Sometimes something as simple as, “You mentioned XX during the session and perhaps next week you can tell me more about it,” can provide the impetus for a client to return.

Charge a Fee – I’m not in private practice so I can’t implement this for my clients but some private practitioners and agencies will charge a fee for a no-show or cancellation less than 24-48 hours before the session.  It’s not about beating the client over the head with fees but rather making it very clear that counseling services are indeed a service and a missed session without prior notification may cause a counselor to miss providing that service to another paying client.  Charging a no-show or late cancellation fee certainly makes one reconsider blowing off the counselor for that re-run of any-old reality show.

End it with Positivity – Therapy can be tough. Anyone who has ever been a client can tell you there are days that you want to just melt into the couch and be done with the whole thing.  I make it a point to leave some time at the end of a hard session to summarize and pull together pieces for the client, to acknowledge the difficulties faced during the session, and to appreciate the courage it took to engage fully. It instills a sense of accomplishment for sifting through the issues and as a reminder that therapy is a process and it’s not always easy but sticking with it can yield life changing results.

How do others proactively (or retroactively) deal with clients that cancel, don’t show, or simply never return?