Monday, April 23, 2012

Enjoy the Silence

Some clients will talk your ear off.  The moment you pick up the phone or step in the door you learn to expect an onslaught of questions, queries, observations, gossip, laments and explanations.  It can be hard to get a word in edgewise.  We learn a lot about these clients thanks to their willingness to share (or over-share as the case may be).  As workers, we work over time to develop this verbosity into opportunities for meaningful and constructive conversations.

With other clients the opposite is true.  Getting a full sentence out of them may be like pulling teeth.  I have two such clients right now, each with a very different basis for their (relative) silence. 

One is a relatively new client to me.  She has a long history of schizophrenia and “non-responsiveness to treatment”.  Part of the problem is that her mother speaks for her.  So we try to meet outside the house.  Our meeting tend to go along the same lines every time.  I greet her, ask some general questions (what have you been doing this week?  Anything good on tv?  How do you like the weather? etc) , try to bring up items from previous meetings, ask about plans.  Sometimes there is a head nod in reply.  Sometimes a quiet one or two word answer, which may or may not be related to the question.  Sometimes a moment of silence followed by “sorry, what did you say?” 
I can see that she’s struggling.  She talks to the voices a lot more than she does to me.  Under her breath, so I can’t quite hear.  She pushes on her eyes, opens and closes them repeatedly without looking at me.  She puts her head up and down off the table.  She has a lot going on, and I do get the impression that she’s trying to be present for our conversation while all these other things are going on for her. 
Slowly it’s getting better.  She is maybe getting used to me, will ask me questions sometimes, will give me a few words more of response each time.  I’ve referred her to a new psychiatrist who I think (hope) might progress where the last one stalled.  I’m working with her family on letting her speak for herself.  We’ll see how it goes.

The other is a long-time client.  We’ve worked together about 3 years.  I’ve seen him through several ups and downs.  But the silence is a new thing.  It’s not even silence per se, but quietness.  I ask a question and he says something in response but the volume knob must be turned to 1 because I can’t hear.  I ask him to repeat himself and he may or may not.  Several times I’ve resorted to being blunt “I’d really like to talk to you, but I’m finding it hard to hear what you say.  Can you speak up?”  This goes nowhere.  When I can hear him, I’m not sure I understand the content.  It’s tangential, it’s rambling, the associations are loose, as they say. 

It’s an important skill in the toolbox for every good counsellor – being comfortable with silence.  We are often invading people’s private spaces, their homes, the personal lives with our assessments and surveys and mandatory home visits.  We discuss difficult and painful subject matters.  We inquire about things some clients never may have spoken aloud to another person.  Sometimes the reasons are unclear.

So what can I do in these situations?  Show up.  Keep talking.  Give them space.  Catch myself when I’m becoming frustrated.  I’ve got the luxury (ha!) of working in a long-term program, so hopefully I can give them as much time, space and talk as they need before we have to say we’re not getting any work done so discharge becomes necessary.

Any other ways you can think of to support a client who is having trouble communicating?  

Wednesday, April 18, 2012

Role Reversal

Confession time.

The past couple months haven’t been my best.  In truth, the February/March time of year are usually when I struggle most with how I feel.  So this year has been no exception.

When I get depressed I have trouble focusing, lack motivation, become short-tempered with people.  I get chest pains and headache and I want to sleep all the time.  Pretty standard fare.  I usually cope with this by taking vitamin d, getting exercise, going to bed on time and generally making sure I practice self-care. 

As you might suspect (or know from your own experience) being a mental health worker does not make me immune to these things or perfect at coping with them.  It also doesn’t make me necessarily receptive to help.  Hey, I’m the one who is supposed to be doing the helping, right?

That particular kind of thinking is ironically what seems to have helped get back on the upswing recently.  So far this year I had been feeling particularly low.  It was starting to cause a lot of stress for me and my family.  My partner, who has had to deal with much harder issues than me basically sat me down and had an “understanding” talk with me.  At first I felt resentful, in all honesty because what he was saying is usually what I tell him to do.  Who is he to tell me how to feel better?  And then I had my “a-ha” moment!  I shouldn’t be resenting him for telling me what I already know – I should be using what I already know.  I had been totally lacking in self-perspective and had my defenses up so high I didn’t want to hear my own good advice. 

I’m not saying any of this to pat myself on the back.  It’s more to record and reaffirm what worked for me, because sometimes I have to work to remember.  There are challenges to being on both the giving and receiving sides of help, especially if you are more used to one than the other. 

Have you ever been a helper who needed to accept help?  Have you been able to use your experiences of being helped to pass along to others?  Leave a note in the comments.

Monday, April 16, 2012

Mini-rant of the day

Why why WHY doesn't ODSP cover more dental expenses?

My client has three teeth left.  THREE.  We found a clinic that will waive their fee for extraction, but dentures have to be made elsewhere and would cost him about $500 each (upper and lower).

I guess it's not "emergency dental care" but does this ensure an acceptable standard of living?  From what I understand some outside agency determines eligibility for dentures.  Crap, now I have to get on the phone and figure out if he can appeal or something.  I probably should have known this too, before I got his hopes up that he could get some teeth.

Bleg.  /endRant

Wednesday, April 11, 2012

Sweet, sweet fundraising

The agency I work for is a non-profit.  This means that we run off of government funding, grants, donations and the like.  This is generally okay with me.  Although I like getting paid, I don’t like making money off of people.  Way back when I was a student, I had a retail job.  I was generally an excellent employee (obviously), except my numbers sucked because I just wasn’t comfortable pushing people to spend money.  Anyway, this is getting off track.

The point is – DONATIONS.  They are great.  Altruism is a wonderful thing.  People give money so we can keep our doors open helping others.  In my personal life I donate to a number of worthy causes as much as I feel I can.

One thing that happens a lot where I work bugs me however.  Internal fundraising.  The United Way drive (since we have programs funded by them), the loose change collections to fund an upcoming special event, the membership drives for which you pay an annual fee, collecting contributions for the silent auction, the cookie dough sales, whatever.  More so than when I worked at other places, it seems almost every month there is a new way they are looking for money.  Isn’t it enough that I work for you people for a pittance?* 

I may have ranted about this to co-workers before.  I may have complained about it a bit at team meetings. 

But then.  This afternoon I am sitting at my desk trying not to let my mind wander as I catch up on notes, but it’s happening – that infamous 3:00 wall.  I’m so hungry I can’t even think.  What to do?  Search my lunch bag and eat the half a stale granola bar that is left in there for some reason.  Not cutting it.  Search my desk drawers, come up with an old pack of soup crackers.  Not cutting it.  Until like magic, she appears! 

“hey Nectarine!  Team SuperAmazing is having a bake sale for the upcoming (enter name of agency fund-raising event).  We have chocolate chip cookies, brownies, lemon…”

Stop.  You had me at chocolate chip!  And there was free lemonade to boot!  Internal fundraising, me and my tummy thank you.  I have never been so happy to contribute.

*it’s not actually a pittance, I am grateful for the income I have.  But it’s not exactly big bucks either

Tuesday, April 10, 2012

Mug Shot Memories

So we have to have ID badges for work now.  I had my picture taken a while ago, at a moment when I was rather unprepared.

The badge showed up today.  I look totally stoned* in the picture.

It's better than one I had for a job many years ago.  At  the time I had dyed my hair blonde and happened to be wearing a light coloured shirt.  This is where I should mention too that my skin tends to be paper-white.

The pic was taken in front of a white wall with a very flash-y camera.  I looked like a glowing yellow light instead of a person.  There was sort of a halo with eyes in the middle!

*I wasn't.