I should probably emphasize that this was my first year providing traditional therapy. Meaning an adult came into my office routinely and we met for 50 mins. My previous clinical experience was in-home or community-based and the designated population was children and teenagers. “Sessions” were often hours long and sometimes included parents or other family members. That experience was much different than my first practicum experience as a doctoral student.
The past year exposed me to diagnoses such as major depression, social anxiety, bipolar disorder, alcohol abuse, PTSD, and generalized anxiety (among others). I also worked with an HIV+ client for the first time. This year introduced me to safety planning for folks struggling with suicidal thoughts and collaborating with professionals in different disciplines, such as nurse practitioners and probation officers. I spent my first year as a practicum clinician in an integrated care setting (where medical and dental services were also available), which impacted the diagnoses on my case load as well as how I approached treatment. For example, battling anxiety in addition to a life changing medical issue presents unique concerns. It was my (and my supervisor’s) job to address those concerns. I chose to share the diagnoses I commonly came across because 1) I assumed y’all would like to know and 2) for normalization.
What’s important however, is what I learned from working on these cases. The biggest lesson I learned (from a diagnostic perspective) is that despite the same label, each diagnosis manifested differently for each client. I’d say more than half of my caseload was experiencing depression of some sort – but no symptoms were completely identical. Please don’t interpret that to mean that the criteria for major depressive disorder is subject to change and can be revised to match your experience or perception of depression – if someone doesn’t meet the criteria, the diagnosis is inappropriate. Depressive symptoms do not equal major depression. Nonetheless, diagnoses once felt like only words on a page in a very heavy book; they’ve come to life this year.
I learned that the definition of health and identifying progress is crucial to success in therapy. Let me ask you this: if you entered therapy today for a concern you’re having, how would you know when you no longer need your therapist?
Therapy is seldom a long-term relationship. It isn’t supposed to be.
As termination and pre-termination approached, I explored how the work I did with my clients was helpful or ineffective. Rarely did anyone say they would have liked for us to do things differently. I gave clients a chance to think about and share what was useful for them. One client in particular (one of my favorites if I’m allowed to say), gave me the opportunity to challenge her when I realized she’d been in therapy for years but spent sessions sharing information about everyone except herself. Literally with minutes left she’d drop a major bomb about herself (e.g., I lost my job two days ago) which was impossible to fully process. It came to my attention that therapy itself was what was helpful, and sometimes folks need a reminder that therapy is hard work. Despite the media portrayal of therapy as this place where you tell a stranger your business while relaxing bare foot on an expensive couch under dim lighting, that’s not exactly what happens. Anyway, I brought it to the client’s attention that I was aware coming into sessions became a place to be heard, not a place to actively address his/her depression, which brings me to my next point….the role of relationships.
A different client of mine entered therapy for anxiety, but was very vocal about his/her limited social circle. Similar to the client I challenged, this client had nearly nobody to socialize with. I wasn’t prepared to listen to someone rhetorically ask why people don’t want to befriend him/her. Despite this person’s generalized anxiety, sometimes I thought he/she came to see me in therapy because there was nobody else. Relationships are powerful – be grateful for the love you receive and the friends you have. If you’ve never been without them, you have no idea what it’s like to do this life thing by yourself. How would life be different for you if you couldn’t ask anyone to have dinner and wine at home with you after a long day at work?
In addition to the role of relationships, I was able to witness how people perceive and evaluate life circumstances differently. Each therapist/mental health provider adopts a therapeutic orientation – how the provider examines and understands mental health related issues. My orientation is integrated, but primarily cognitive-behavioral, meaning I attribute diagnoses to the interaction between someone’s thoughts, feelings, and behaviors. Hence, my emphasis on subjective perception and cognitions. I’m a firm believer that altering thinking patterns and challenging ourselves cognitively is helpful for managing or overcoming several psychological disorders. Consider the difference between thinking, “I’m so stupid, I bet everyone saw me wave” versus, “maybe she didn’t see me” after waving at a neighbor in the grocery store who doesn’t wave back.
I noticed that identity and defining oneself were also (nearly always) areas of concern. For some, identity overall (who am I?), and for others it may have been identity with(out) their diagnosis (who am I without agoraphobia?). I don’t think I’ve ever self-reflected the way I did last year. I felt like I was constantly reevaluating what I thought I knew about myself and the world around me. Many people open discussion about self-love, but what is it really? Better yet – how do people achieve it? Is it something that can be achieved for everyone? Is self-love and self-acceptance equivalent? Does lacking one (or both) contribute to psychological issues?
I don’t know.
Maybe I’ll revisit this during year two.
Cheers to making it this far and surviving to tell the story.
Peace, Love & Lil Wayne,