Dear Ray: A note to a new mental health practioner

by Shaun Kieran

Dear Ray:

I remember our last chat in the lobby outside the auditorium waiting for the main speaker to close out the conference. You seemed a little wistful compared to our previous encounters, and I wondered whether being up to your Adams apple in clients now is more of a cold shower than you’d anticipated.

As I drove away, I knew I wanted to send you a short note of support, and, if it doesn’t bother you, pass along some tidbits from my experience that might apply to what you’re going through now. I’m sure you’ll ultimately be fine with the clients, but it is a bit of a jolt to see how unattentive, or unreliable, seemingly uninterested in their own problems, unappreciative, and how truly damaged so many are. Not all, as I know you know, and I also know you have plenty of clients you do, very much, look forward to seeing.

Still, there’s always some disillusionment that happens when you’re geared up to engage a client, and then receive very little real energy for that engagement coming toward you. We tend to imagine ourselves having these wonderful, dynamic sessions with our clients – validating their struggles, emphasizing strengths, and by the respect and attention we give to their life stories, affirm the existence of hope – for them, and yourself.

Sadly, it can start to feel less like active treatment, and more like custodial care – or even worse, a cynical, going-through-the-motions paperwork process. Some show up (maybe) and therefore continue to earn the DSM – IV diagnostic label you give them, which means that the government money is released and pays Medicaid, or SSI disability, etc. – as well as your salary, your boss’s salary, and the cost of the paperclips.

You’ll get past that, but first you have to go through it.

Respecting clients DOES matter, of course. Just like everyone else, they can sense your true state of mind, and how you really feel about being there with them for that session. I’m certain you’ll navigate all of this, sort out the real from the ideal, and reconcile yourself to it. Think of it as “tempered idealism.”

Your colleagues may be a different matter, however, and that’s where it can be especially hard. I’ve told you how fortunate I was that my first job was virtually a textbook model for “how it ought to be.” We were there for each other, we talked cases, we talked ideas, we fretted about the patients together, we went out for beers after the shift. It was great – and it’s been downhill ever since.

These days, it’s more like another workplace, not a sanctuary for healing, and maybe that’s simply unavoidable. Your colleagues, like you, make their own peace with the work, and then, often without realizing it, become disengaged from all the anger, sorrow, fear, and despair. It shows up in the lack of interest in talking about cases or engaging in professional collegiality, going home at the dot of 5:30, and a pervasive, but usually cheerful cynicism about virtually everything.

But you’ll notice right away, there will be some colleagues who stand out, and rise above. They fight the cynicism, they like the clients, they like the work. Respond to them, Ray. Support those people. Say thanks to those people. Cherish those people.

As I reflect on who “makes it,” it seems to boil down to a combination of temperament, curiosity, experiential reinforcement, and sometimes nothing more than pure dumb luck with some of the early cases. I remember an enthusiastic young colleague I was sure had the right stuff for the long haul, but she was unlucky, and got caught in a buzzsaw – a particularly sick client, poor supervision, paperwork that wasn’t bad (but could have been better), a family out for blood, and lawyers hovering. She crawled away.

You feel like someone wired to go the distance, Ray. Who knows. You’ll want to develop a style as freed-up as possible, while maintaining that reliable professionalism. As you know I began evolving my Coaching techniques in the late 80’s, and it kept me going in clinical work for years.

You do need to have that emotional energy to go in each day, sleeves rolled up, knowing what you do is important, and engage, listen and learn, teach, advocate for hope, really try to make a difference … and then you need to drop the ball, go home to your family, and make a good life for yourself there. You’ll pick up the ball the next day.

It’s meaningful, noble work, Ray. Truly. And, who knows – you may have the right kind of wiring, enough savvy, and the ambition to someday parlay your experiences and real, hard-won skills into a thriving private practice – writing, speaking, coaching, teaching, or consulting.

For now, it’s dues time. Case after case.

Learn. Be present. Give.

I’m betting you won’t regret it.

Warm regards,

Shaun

 

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