Denial

Some of you may remember that a while back, when I was first interviewing for (and soon after landed) my first “real” job, I had a stage system in which denial was the first stage of attempting to find employment after graduation. I don’t have a theory for how it works once you land that job (once the stages have all been successfully resolved, I’ll keep you informed), but what I do know is that there’s a serious case of denial going on, and it might be with every new person who has entered a demanding, somewhat thankless field that thinks they can handle the pressure.

The other night, I was at a cousin’s going-away party and was approached by my aunt and her best friend. These two women have been in the field of counseling psychology for over 30 years and encapsulate what I want to be when I grow up both professionally and personally. My aunt asks the seemingly innocuous question: “how’s work going?” And I respond with the go-to answer that I thought I have perfected over the years – “good, it’s fine!”

Now, if you know anything about experienced therapists, you know that it’s impossible to lie to them (when when you’ve been lying to yourself for the past five months), because they can read right through your BS and somehow convince you to relinquish the power of denial. “Fine? You’re billing 33 hours of direct client contact a week and you’re fine? Really?” When I in one form or another convey to my clients that they’re in denial, I’m usually met with a little bit of resistance. In this case, I start tearing up and finally admit to myself that I’m overworked, underpaid, and cannot possibly be providing high-quality therapy for 33+ clients a week. That many of my clients have extensive trauma histories, a few personality disorders, and some pretty serious anger issues that I’m too inexperienced to fully make an impact. My aunt and best friend normalize and validate these feelings for me, letting me know that even as experienced therapists, they would not be able to handle the pressure and stresses that come with maintaining such a large caseload. That if they were me, they would also do what I do – come home after working a long day, maybe go for a run (they both laughed at this one), make dinner, verbally take their aggression and emotional turmoil out on their spouse for no reason other than the fact that he’s there, crash at 10:30, and not have time mental energy to focus on anything else (and now you can see why I haven’t written a blog post for the past four or five months…)

In my workplace, there are a select few that are outwardly vocal about the stress that comes along with being a therapist in a community mental health agency. As someone that’s prided myself on my optimism and enthusiasm, I try to tell people that it’s not that bad, it’s a temporary job, and that we’re working our best to help the people that want to come in for actual help and soul-searching. And that we at least have a supportive and understanding boss who wants to see us grow as people and as counselors, because a lot of workplaces don’t have that. That yes, while some parts of the position are less-than-ideal (paperwork! Having to choose between an awesome training and scheduling a client so you can bill for an hour! Having to worry about meeting quota on a weekly basis! Down with the system!), it’s still a job that will eventually launch our careers and that we are helping people in a difficult population to reach their full potential. And telling everyone these things, I had to believe them too.

So where did this denial come from? Well, as a walking cliche, I’m going to go with the obvious answer and say “my parents” and “oldest child syndrome.” I know in my heart that they didn’t mean to instill this sense of denial in me, and that they were wonderful parents and did everything they could to support me in my professional and personal growth. Really, I’ve been pretty damn lucky to have the parents I do and I wouldn’t trade them for anyone in the world (and I promise I’m not writing this because my mom is the one person that frequents this blog on a regular basis). But I definitely internalized the “work hard and suck it up” attitude that they taught me over the past 25 years.

Now, they never expected perfection from me (“just try your best honey”), and I’ve been told several times that they’re incredibly proud of my hard work and the things that I’m doing. But you see, they’re super-people. Nobody’s perfect, but they come pretty damn close. For the past 30 some years, they have worked as accomplished surgeons. At the same time, they managed to raise three relatively well-adjusted children, actively engage in volunteer efforts, maintain an active social life, exercise, and have fun. Oh, did I mention that they’re still married after 27 years? Sure, they complained about work from time to time, but very rarely mentioned how stressful and demanding their jobs and lives actually are. I’m the oldest of three siblings. I didn’t have anyone to compare myself to, so I compared myself to my parents, made friends with the ambitious genius kids in middle and high school, and thought that I could suck it up and make it through anything, no matter how hard it was. There was the internalization that eventually, I could achieve that perfection and maintain that perfectly balanced lifestyle.

Fast forward to now. After bursting into tears in front of my supervisor about how I can’t handle the pressure and stress rationally discussing my concerns with my supervisor (though if there was any field to  show emotion to your boss and have he or she understand and not be totally freaked out, it’s the mental health field), she, like my aunt and aunt’s friend, normalized these things for me. That it’s okay not be Superwoman. That the first year is like “therapist bootcamp,” and that maybe it’s okay to actually admit that things are difficult. That as therapists, we advocate for self-care in our clients and intellectually know how important it is for us, but rarely engage in it to the extent that we should. And that she would try to help me come up with some other options to make things somewhat less stressful.

I’m still considering my options. Find another job part-time that isn’t so demanding to make up for the lost funds from taking on less hours at my job. Budget for a significant pay cut but find time and mental space to engage in other activities. Go back to school. Or strive to be Superwoman, but knowing and accepting that I’ll never be that person, and do my job to the best of my abilities. But as humanizing as it is, I’m relieved to no longer be lying to myself and admitting to my stress, flaws, and insecurities when it comes to this job.

In therapy, they say once you get out of denial and admit to yourself that there’s a problem, the real work can begin.

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2 thoughts on “Denial

  1. Are your current case load and the general conditions of working in this setting pretty typical? Is it so hard because it’s your first year, and things will get easier as you gain experience and settle in? Or is this kind of what the career is like for the long haul? Is going into private practice an option (now, or ever?) I ask partly for myself, as somebody whose life has been powerfully improved by her therapist and who dreams about switching majors and then pursuing MSW to follow in her footsteps. I first began seeing her at a private agency and then she recently started her own private practice; she’s a good 12 years into her career, but it appears to be sustainable and maybe even enjoyable at times. I know she has tons of paperwork (she accepts many types of insurance that her colleagues won’t bother with) and that it’s not all fun and games (i alone must be draining, as I’m processing some pretty heavy trauma.) But she seems very upbeat, very passionate about her work. She gets really excited about the occasional training she goes to (last year it was narrative therapy training, and she said it was life-changing for her.) She even told me once, in a temporary moment where her “therapist wall” came down, that i bring a lot of joy into her life. I’ve had some major growth with her in 4 years and become very attached to her, and had begun to fret about the one-sidedness of tje relationship, but that quick glimpse of that real side of her was a huge comfort. I’m sure it’s difficult and challenging work, probably most of the time, but there are enjoyable and rewarding moments. So, long story short, how difficult is it to get to that point? Am i kidding myself to think i could complete my degree, go to grad school, and maybe find something similar in a reasonable amount of time? Or is it rare to build a thriving private practice like that?

    I really enjoy your posts, and look forward to reading more as you’re able to share. I’m sorry things are so tough right now. I hope you will find a better balance soon, whatever that looks like for you!
    A

    • This response could easily be its own blog post, so bear with me. 🙂

      I think it may be a combination of several things that you mentioned. I work in a community mental health setting that expects their full-time, contracted therapists who receive benefits to bill 33 hours a week (one 60 minute session not necessarily including paperwork = one billable hour). Occasionally we get to bill for trainings and we have one hour of group supervision every other week that we bill for, but other than that, it’s at least 33 hours a week of client contact. At my facility, you can reduce your billable hours to 25 or 30 hours, but with that reduction comes a pretty hefty pay cut. Not all outpatient facilities have the same expectations, but many pay at a Fee For Service rate in which you do not make a salary or receive benefits, paid time off, etc and only get paid for hours that people show up.

      I have one other colleague that has sustained 33 hours a week (the rest either dropped to 25 or are doing Fee For Service), and she over a year into her training and working to get her LCSW (which, like getting an LPC, involves getting enough supervised working hours post-graduation). She happens to also run a successful group, which helps her in obtaining the hours needed to make quota. Seeing the number of people I do per week is almost unheard of, and most licensed clinicians that have years of experience have told me that they would have a hard time seeing that many clients a week (many see between 22 and 27). As I said, every facility is different, and I’m told that things get a little bit easier once you are licensed and there are more available opportunities to grow and develop as a clinician. I do think a lot of people starting out in the professional counseling/social work field are overworked (unless they get extremely lucky) and don’t get some of their needs met in return.

      At the same time, I happened to go right into graduate school after college. I worked through college and graduate school, but never worked a permanent, full-time job. It could just be that I’m not used to working one full-time job and doing the same thing every day, so I’m not sure if you have a similar situation or view. This post was written after a particularly difficult few weeks with some crisis intervention, so I suppose it all came through on the internet. It happens.

      I don’t think you’re kidding yourself – just know that it’s going to be difficult work with a meager salary in the process of getting licensed. If you’re passionate about your work, you’ll be able to easily push through and find moments where you really enjoy your job (it may not seem like it, but I do love what I do and it’s worth the tough times to see progress in the people that are working). Also, it’s great that your therapist shared that with you. It shows that she really values her work and her clients, which is so important in this field. If she can inspire you to do the same to others, that’s a good therapist.

      Best of luck in whatever you decide to do!

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