Like the baby seals that are currently being birthed and raised at La Jolla Cove, I am slowly making my way as an associate marriage and family therapist. I feel so unsure of myself and am so hard on myself and I expect to be awesome immediately. I had some moments of feelings of sheer failure and moments of confidence and success.
The problem is me. The environment of the job is great! Everyone is super nice and helpful and everyone loves the Clinical Director, my Supervisor. She is so kind and understanding of my insecurities and tries to tell me that I cannot possibly expect myself to be awesome right out of the gate. She is right, of course. The thing is all the old feelings of incompetence that I had during my practicum training came barreling back to me as I reflected on my first two weeks on the job.
As I sat in the recliner chair, with three pillows under my knees, to ease the chronic pain in my back, I realized what I needed to do to be successful at this job. I need to interact more with the clients and work on my rapport with everyone. A lot of them smoke, and so does my boss, and she will hang out with them because of the designated smoking area. I get triggered to want to smoke when I smell smoke or I’ll get nauseous because of the smoke and have to step away from the area. For that reason, I really didn’t put myself out there except in the group sessions when I was facilitating the group.
My boss had me doing psycho-education groups this week using the curriculum from the treatment center. Then she assigned me some utilization reviews on clients that were not mine. These URs, as they are referred to, were like the case conceptualizations in grad school. I wasn’t too confident in my abilities to do those and they took me literally days to complete. I couldn’t do them in class, I had to take them home and think about the case and study it. I got good grades on them but I was not prepared to do them while I was doing groups and seeing clients. Being part time limited my hours to work and most of the day is taken up running groups and seeing clients. To make a long story short, I got into this mindset of “oh my god she’s going to fire me”, because I am not getting the URs done. I expect perfection out of myself and tear myself down if I don’t grasp concepts or can’t complete a task quickly. I know. It’s a problem.
My supervisor was very supportive and understanding and told me everything was going to be OK, that I am still learning and to just take a deep breath and basically soldier on. She is overworked and trying to bring on new staff and expand the treatment center at the same time. The owner has already vacated his office which is now being used as a group therapy room. Three or four people, besides myself, have been hired in the past two weeks. Offices are being moved around and switched between people. The office that I am in is temporary until a full-time licensed therapist is hired. There is only one licensed therapist besides my boss and the rest of the staff are associate therapists (me and one other) and behavioral health technicians. The BHTs, as we call them, are numerous and far out number the therapists. They are charged with the daily operations of getting clients to their groups, therapy, and basically dealing directly with the clients all day long.
As therapists, we do group therapy and individual therapy and then we have to write progress notes on, not only our individual therapy sessions with our clients, but also for each client in the group therapy session. It’s a lot of documentation. It’s like writing, which I enjoy, but I’ve never been quick to create papers and such because I overthink a lot when it’s documenting client sessions. I mean, I have to overthink it as I analyze and assess the clients but my stage of being a novice in the role of therapist makes me overthink my overthinking.
My problem has been the environment and ergonomics of where I am working on my progress notes. Because of the back pain, the most comfortable position for me to write in is the position I am now currently in. Laying in a recliner, half sitting-up with pillows under my knees, is the optimum position to keep my back happy. Once my back is happy, I can concentrate on my thoughts about what I’m doing instead of thinking about how my back hurts.
So, my plan is this weekend is to get some relaxation and maybe study other utilization review notes and practice them. I’ve also decided that I’m going to use music and mindful visualizations in the beginning of groups to settle the clients down before I start the curriculum. They are all people being treated for their addictions, and some are also being treated for mental illness, as well. We call them the dually-diagnosed. It’s challenging.
More than anything, I have realized that I must “treat” myself first and get into a calm and controlled space, before I walk into group therapy and try to connect with the clients. I really wish my supervisor would let me shadow more meetings as she only allowed me to shadow 2 sessions with one therapist. There are other groups being run by Registered Alcohol and Drug Counselors (RADC) that I would like to sit in on. I believe this will be a way to get to know all the clients and perhaps connect with them more, without hanging out in the smoking section.
But I must be true to myself and do the breathing exercises and mindfulness that I teach to my clients when they are having stress. It’s all about self-care. It’s paramount to a successful career in mental health therapy. I need to make sure I’m taken care of, so then I can help others. Breathe in….breathe out…breathe in…breathe out… now picture yourself floating on an inner tube, at the beach in shallow water, with no one else around, except the sounds of the ocean and the rise and fall of the waves…..