Tuesday, February 2, 2010

a therapy conundrum

Alright, imagine you are a therapist and a guy comes in and tells you that he has depression. Yay depression, there are about a million treatment models that are proven to work for that.

Now imagine that you find out the guy is depressed partly because his girlfriend is physically abusing him. Suddenly you have a much bigger psychosocial issue; hell, the guy probably should have some sort of extreme emotional reaction to that because his situation is extreme. Is it just depression now? Is it self-esteem? Would he be better served by a case manager, or a cop, or a lawyer?

Now imagine that it turns out that the guy ends up going from one abusive relationship to another, always finding women to play out the same pattern. Kind of puts the ball back in a regular private therapist's court. Do you support him so that he feels stronger and more confident, or do you confront him about his pattern in an effort to get him to change? Both address relevant causal links in the chain of him getting hurt, but at slightly different levels. The second (deeper) one takes longer but without addressing it the guy will probably keep replaying the same issues in one form or another. The first one probably will go more quickly and solve a lot of the immediate problem (say, he leaves the current relationship and starts taking better care of himself) but there are still subterranean issues that could just as easily re-emerge. And what if there are even deeper layers nested within that?

These are all questions that I have no better idea how to address since I started my program, which is a little frustrating. Oh, I think I know what my supervisors would say, that it is more important to have a clear sense of the questions that it is to have a good answer for them, and that by making these things conscious it will allow you to address the individual client's concerns better. I remain unsatisfied. I'm at the part of the learning process where I know a crap-load about what I don't know without enough framework to really be useful yet. It's a crappy spot in the learning curve.

Monday, January 11, 2010


I just finished my first 25-hour overnight shift at Conard, which will be a weekly thing.

Pros: About $300 after taxes for working once a week in a job where I will have a ton of time to do homework.

Cons: I am soul-crushingly tired. Something about the resonance of a place where so many people pass through, I guess, but I don't think I will ever be able to get more than a few hours of sleep while working there. But then again, I see this as the logical extension of my career path; I mean, I'm already slowly selling my sanity for money, so my soul isn't that big a leap.

I do worry though that I may begin to over-stretch a little. To be fair, it isn't like I have kids or anything approaching a long-term relationship, so I really ought to have all the time in the world to work a job and go to school. It's just that I'm not exactly famous for my time-management skills, and I would like to see my friends occasionally. Not having a weekend makes that more difficult, because right now Saturday is my only free day.

Which of course means that if I do want to make time, I have to start planning things for over the week, which means most likely falling behind on my work, let alone maybe occasionally making it the gym or doing my own cooking or meditating or any of the other crap that I like to tease myself into thinking I might occasionally do. Plus burn-out is bad.

But I have to look at it this way: this year cannot possibly suck worse than last one did. Last year started off okay and just kept sliding. Not that getting into grad school wasn't amazing, because it was, and not that I don't have a lot of awesome people in my life, because I do. But last year was the poster-child for every bad decision or error in judgment rebounding in painful and nearly immediate karma. It was the year of mostly getting my ass handed to me.

So I declare this the year of "It's gonna be a good fucking year!" And I'm not going to let the fact that I am tired as hell and already overloaded with schoolwork and struggling to maintain a social life and have no idea what the hell I'm doing get in the way of that.

Fuck off, me-karma.