Ready…Steady…Work!!

Another example of how ineffective this place was, could be literally heard through the walls. Since the walls were thin, many times the staff could overhear what was being said in session in the next room.  The “therapist” next to me asked me to play a CD of something, because she could hear my client (he had kind of a loud voice).

I chose to play Tool.  She complained about that, too, stating her client “doesn’t like Tool.” Completely missing the point, as it was just supposed to be about not overhearing confidential sessions, not whether or not my taste in music was compatible with her client’s.

My own client loved Tool, by the way.  Had he loved, say, Justin Bieber, I would have played him instead – you meet the clients where they are, not where you are.  The point is to make your own client feel at ease, not struggle with them over what kind of music they like – or to accomodate what kind of music the “therapist” in the next room over likes.

Regarding that “therapist’s” sessions, on more than one occasion I heard her discussing “American Idol”, various movies and TV shows, and fashion with her clients.

Not as metaphors.  This is what her “therapy” was.

In other words, she wasn’t conducting therapy, she was chatting with clients as if they were friends, and then making up things to write in the therapy notes.

I assume she was making things up, as I cannot imagine her notes stated things like, “Patient and therapist discussed the relative merits of various designer shoes”, or “Patient expressed dismay at her favorite contestant being voted off ‘American Idol’, while declaring her dislike of the band Tool”.

That would also be incorrectly assuming she even knew the proper way to write a therapy note, content aside.   I saw her notes.  I have no idea how she managed to keep her job for so long, except that her notes were timely.

It’s easy to write timely therapy notes when you don’t actually conduct therapy, because you can just make shit up.

And turning in paperwork, or writing in the electronic medical record, within the timeframes dictated by various agencies is all that matters to corporations like this.

Aside #4: In the medical field, you have only so much time to submit certain types of documentation. For example, you have 3 days from the date of admission to submit certain admission paperwork, and all paperwork is dated – in the case of electronic notes, you cannot alter the date, ever.  The date you submit it is the date it gets.  A company can get in a lot of trouble with Medicare, JCAHO (accrediting body), and others if it does not have paperwork filed/submitted in a timely manner.  

Also, at this particular company, I personally saw “therapists” backdate notes, and in one case I saw someone forge a patient’s signature.  I reported all this to the proper outside agencies.  I don’t know what happened – I suspect, nothing.  Because that’s usually what happens.

Ironically, when I was fired from this particular company – for not calling in sick the day after the methadone clinic’s doctor took me to my primary care doctor when I threw out my back at work (they stated that just telling the doctor to let them know I wouldn’t be in wasn’t good enough) – the official reason stated was “lack of job performance, and being behind in paperwork.”

Aside #5: I had 4 letters of recommendation from my previous employer – Delta Medical, the only place I have ever worked as a therapist where I didn’t get fired – specifically praising me for my timely and professionally completed paperwork.  

In fact, at one place I worked (not Delta, but the hospital where I got fired for taking the patients’ sides against hospital bullshit), when JCAHO pulled a surprise inspection, my supervisor gave them my files and had them interview me – that’s how good I am at that.

So, that methadone place was a mess.

My immediate supervisor had taken over files from the last person they had fired – files of clients who became mine once I was hired – and was months behind before she dumped them on me.  So I never could catch up.  I heard later, a few months after they fired me, they fired her for that.

So, they knew.  They knew what was going on in terms of paperwork, and the real issue with me working there was…I was conducting therapy.  I was the only therapist who had my own therapeutic material, the only one with educational material in my bookshelf, the only one whose groups were consistently full.

And I was the only therapist who came to group therapy one morning with a top hat and cane, to make things interesting and to get clients’ attention.  That kind of thing, though effective, will basically make you a pariah to the rest of your co-workers – you know, the “creative” ones who play Hangman.

To continue about the profession, in general…

Typically, therapists in outpatient facilities have 25-30 clients they are responsible for, and think about it: we have to see each one of them at least once a week at the beginning, and have at least two family sessions before they’re discharged – these are insurance requirements.  Then we have to conduct group therapy several times a week.

We also have to write and update treatment plans, go to seemingly endless snore-fests called “treatment team meetings” (which are rarely helpful for either therapist or patient, unless you work with people who know what they’re doing), document everything clients (and their familes/friends) say over the phone…document, document, document.

Because…CYA (cover your ass).  Or, more accurately, CTCA (cover the company’s ass).

It’s too much work.  And the more clients the place has (“census”), the fewer therapists on staff, the lesser educated the staff (BA, not MA/MS) – so the less the staff is paid – the more money the facility makes.  Cha-ching!

These “therapists” regularly slept in the building on weekends, in order to keep up.  And they weren’t paid to do that, this was all free labor because they were so terrified of being fired.

That’s was just one example of what goes on in places where therapists work.  It’s unfortunately very common.

It’s profitable to run a business where you have a lot of repeat customers.  The problem with that in healthcare is, you make a profit by keeping people sick.

And that’s wrong.

There is no way to justify that.  “Every business needs to make a profit” does not even touch the devastating effect this goal has on people who are ill.

To me, it’s like having a TV show whose ratings are really high because their whole plot is showing people being executed.  For real.  On Pay-Per-View.

That doesn’t happen, and why?  Because, fortunately, society in general finds that idea disgusting.  “We need to make a profit” doesn’t excuse that type of TV show.

And it shouldn’t excuse keeping people suffering in mental healthcare facilities, sometimes for life.  No, gone are the days when we could “lock ’em up for life” (mostly) in psychiatric hospitals, but when you:

~ Exploit peoples’ loneliness by being their “friend” instead of their therapist…

~ Conduct “therapy sessions” that consist of listening to a client vent, over and over again, for months and even years, and that’s all the session consists of…

~ Lose complete control over the client/therapist dynamic and take great pains not to conduct any therapeutic work in session (so she/he won’t complain and get you fired)…

~ Over-step your boundaries and use the sessions to talk to the client about your problems…

…you may as well be locking clients up for life, because you are not helping them and they are not going to get better.  Period.

And companies love these kinds of therapists – well they must, surely, because there are so many of them!

Potentially overworked and being confronted with the choice of “do I make sure my paperwork is perfect while I do notes while in session (a huge no-no, or should be) or make things up…

…or do I actually conduct therapy and risk the wrath of my co-workers (for making them look incompetent)…

…or risk the wrath of the client (for challenging them)…

…or risk the wrath of my boss (for long therapy notes and requests for more time in my everyday schedule to do them)?”

…most people do the easy thing.

So clients stay sick.

But, how was it I managed to get notes done at Delta Medical, do real therapy, and keep my job?

At that time, the company was collectively owned by the employees.

And I had a wonderful boss who understood staffing, always calling me and others in (we were PRN – “as needed”) according to the census numbers.  All the therapists I worked with were on the same page – they wanted patients to get better.

Everyone did therapy.  No one did anything like the things I have previously described.  

Yeah, it does make me feel vindicated that the only place that didn’t fire me was also the only place that gave a damn about patients, and showed it by their practice.

Ha!  But it doesn’t make me any less unemployed.  And since Delta underwent an ownership change, most – if not all – the people I worked with are gone.  Looking up the requirements for employment there as a therapist, I see it now requires a license.

Most LPCs (Licensed Practical Counselors) have their own private practices.  Same with psychologists with “Dr.” in front of their names.

The problem with becoming an LPC is that you need so many hours of “supervision” (I think it’s 3000), and you also have to have certain classes in your academic record, which I do not have (except for some counseling courses through the education dept).

When I was applying for jobs here in PA, I asked about licensing – my idea being that I could work, take night classes, and get supervision.

No one does that here.  All anyone requires is a BA in…something.  Not usually psychology (at least not any I have met), but it’s usually education or social work.  I was told, time and time again, that no one offers supervision, and anyone with an MS/MA is perceived as being too expensive to hire.

At Delta, in 2009, I was making $25/hour (no benefits, though).  But $12/hour was what I was pulling down at the methadone clinic in 2010, my last job.  Good grief, there are people battling to make $15/hour the minimum wage!

So…as much as I want to go back to work, I can’t see how to do that.

Because…ethics.  Humanity.  Empathy.  Really, really wanting to help.  And I think I am a decent therapist, whose patients get better.

But I am really, really sick and tired of living off $8,500/year.

I don’t know what the answer is.  I want to go back to school and get my PhD and license, but I don’t know how to go about doing that without taking out student loans – which I will not ever do. Financing my graduate degree by working as a research assistant would work, but not for a clinical program.

Working and going to school at night would work, if I had transportation, a job, and a graduate program in educational psychology or something similar.

I have no idea how to get the ball rolling on that, having been out of work for 5 years, with a very non-impressive resume that includes being fired from my last job.  Explaining that part of that was due to a moral contradiction between working conditions and ethics, and having PTSD from fleeing someone who tried to kill me on numerous occasions…uh, I can’t see anyone hiring me really, ever again.

PS – On an unrelated note, Nancy got the wheels on Coco.  It took her 2 hours, and some words she told me she usually doesn’t use (the wheels had virtually no instructions).  I paid her 6 cupcakes for her trouble.  And I will be riding today or tomorrow, weather permitting.

Today’s weirdness comes from outer space…and it’s not really weirdness, it’s just super awesome!  From NASA.gov, the pictures from New Horizon’s Pluto fly-by.

For those of you in the future reading this, New Horizons is an unmanned craft sent to take pictures of Pluto.  Totally wonderful and amazing stuff!!

What people may not know is, the man who “discovered” Pluto (Clyde Tombaugh) is hurtling through space right along with New Horizons – sort of.  His ashes are being carried by the craft. His children were in the control room at NASA when the first pictures came in, which I thought was really nice and respectful of NASA to do.

New Horizons is due to reach the Kuiper Belt in October, if NASA decides to do that and makes a steering correction to get there.  Currently, New Horizons is now 4.6 billion+ miles from Earth.

Pluto is 1/6 the size of Earth.  That’s really small.  I was going to post a pic illustrating this, but I don’t know how to do that on my laptop, and I don’t know if any pics are fair use.  So, I guess you’ll just have to look it up yourself.  But I can tell you, the pic I did see showed Pluto and Charon (one of its moons) as both fitting superimposed over a map of the USA.

Pretty impressive!!

Today’s recommendation is for…not a movie, not a book, not a TV show, but…

“Sabra” brand Olive Tapenade Hummus.  I just bought some on Monday, and it’s delicious! Comes in a lot of other flavors, too.  And, no, no one sent me a free bowl of it, or paid me to write this (I wish!).

Be good.  Be kind.   Watch this space for a free “VictoriasViewpoint” tote bag!!   I have to design the logo for it, first – any suggestions would be appreciated, as art is definitely not a talent of mine.

 

 

 

 

 

Advertisements

5 thoughts on “Ready…Steady…Work!!

  1. charlies5169

    It seems these days that it’s all about the money. Nothing else matters. Honesty, quality, people’s lives… All that is trumped by profit ( unintentional pun there).

    They ( politicians, corporations, etc.) seem to be obsessed with saving money. Ok, so where do these savings go? You and I never see it. Who’s taking all of these “savings”, and why do knock ourselves out to keep shoveling into someone else’s pocket?

    I could go on, but we have this discussion frequently, so there’s no point rehashing it. I’ll just get myself worked up.

    Well, as usual, I enjoy reading your posts tremendously.

    Like

    Reply
    1. Gray Ammons

      Interesting. I worked doing a follow up program for people doing the methadone program. I would go to their homes and fill out a questionaire and without exageration 90% were using again. The other ten percent were dead or in jail. I was wondering if you were going to start a private counseling clinic that would actually try to get these people to quit. It seems like you have some sound ideas of using a different approach which would include redirecting the addicts thinking process which I believe is the only sound method to get someone to quit. An addictive personality will always be addicted. Counseling should try to find a substitute addiction that is less harmful to society and the individual. Boredom is the greatest demon that addicts must overcome because it allows the mind to manifest whatever demon causes them to trigger using. Finding a volunteer job such as helping at the local animal shelter or hospice work are substitutes that I think would help addicts. Now first thing one would say is you don’t want an addict in a hospital environment where opioids are common usage but seeing how they are used to end the life of a person is very powerful for an addict to see. Many addicts have od’d or had someone od and then were brought back and it adds a good deal of reality to their drug use. It depicts the end because when you use that is where you are headed. Unless you have the genetics of Keith Richards. I’ve rambled long enough but I think you may be onto something. Good luck. Peace, Love, and Understanding

      Liked by 1 person

      Reply
      1. Victoria Post author

        @Charlie:

        Yeah, you’re right – we’ve had this discussion many many times – and both of us get worked up about it on a regular basis lol.

        The best job I ever had was working in a place that did not involve life-changing decisions. It didn’t pay well, and it involved some physical labor, but I loved the people I worked with/for and it was in a place where I would have literally scrubbed toilets (and I did that, too, in that job) in order to stay living there.

        You probably know to what I am referring but suffice to say, barring a miracle, it’s not likely I will have that opportunity again (though they did promise to rehire me if I came back…no, I didn’t get fired from that job, quite the opposite).

        The temptation to just slip back into academic research is strong, but that holds other pressures (publish or perish, which you wouldn’t think I would have a problem with…) and has other kinds of politics, and I’m not sure how I would do in that environment (past successes notwithstanding). There also is very little, if any, age discrimination in that kind of work.

        But I’m fairly sure my major professor has retired by now, along with a few others I know. It might not be easy to find a professor who would take me on as a student.

        @”Gray”:

        I completely agree with you that it is a way of thinking that needs to be addressed, and the focus off the substance. This is what upsets me so much about lawmakers and medical professionals who continue to harp on the drugs themselves, totally ignoring the twisted thought processes that drive an addict’s behavior – their solution is to just make opiates ridiculously hard or impossible to obtain for anything, even end-of-life pain.

        You saw the problem first-hand (well, all 3 of us, living in FC, saw it first-hand) when you did the follow-up with methadone patients. The success rates for any program are very low, even I suspect for AA (which claims anonymity prevents it from disclosing success rates lol oh sure it does), the supposed “gold standard” for treatment.

        In my opinion, cognitive-behavioral therapy is the only thing that works. Like you mentioned, it’s how they think, it’s boredom, and it’s their peers, too.

        I know a couple of people who are “successfully in recovery” who are A&D counselors, who have either just switched addictions (to psychotropic drugs that get them high like Seroquel, to muscle relaxants for minor injuries, to benzos “for the stress of being a counselor”, and to “social drinking”), or who are what we used to call “dry drunks” – not on any substance, but still wreaking havoc in their own lives and others’. They have little to no insight as to how they themselves think/behave, and are fairly easily derailed and relapse back to their drug of choice if they think they won’t get caught.

        Many A&D counselors who are “former addicts” merely work in places where they don’t drug test employees, have supervisors who are also using, or have the people involved in the drug-testing in their pocket or easily fooled. Addicts are very clever that way, and if they spent even half as much time and brainpower doing something decent instead of constantly obsessing over getting high, the world would be a much more productive and positive place.

        I don’t know if my success rate would be any better, but I think at least by focusing on the real problem, it might be. Now I just need the credentials and funding to do it. Somehow. Most days, a lottery win seems like the only way I could do it. 😦 I have no idea how to do any of this, practically-speaking.

        My dream is to do that and to also start up and run a domestic violence shelter, not necessarily connecting the two (that discussion is for another time – oh look! I’ve just now written another blog entry in my own comments section lol).

        Thanks, guys, for your comments!!!

        Liked by 1 person

  2. charlies5169

    Gray,

    You make a really good point as well, as far as addicts finding volunteer jobs. It’s similar to the programs here, and in other states pairing prisoners and dogs to train. It gives them something to focus on besides themselves. It might or might not extrapolate to addicts, but it’s certainly worth trying. Hanging fire just doesn’t work.

    My own experience with addiction is strictly observation. I am a layman and absolutely not an expert and certainly don’t have the background and boots-on-the-ground that you and Victoria have. So I am not an expert (in anything other than being a smartass, I suppose). Like everyone else our age, I’ve seen it in friends and family, coworkers and acquaintances. I saw a lot of it in the AF when I was stationed with a bunch of guys just back from SE Asia. I can’t say it was rampant, but there was a much higher incidence than in the general population. And during the 80s, there was a lot of cocaine and alcohol addiction at the place I was working, from the VP on down. (Don’t even mention tobacco, which is just as bad and deadly.) And, on a personal note, all of this was a huge factor in me straightening myself out.

    Again, like everyone else, I’ve seen the end result when their addictions finally catch up to them for the last time. It’s really heartbreaking when you have to say to yourself they didn’t have to die like that.

    But from that decidedly non-expert standpoint, in my opinion, the current system is certainly not working to anyone’s advantage other than the corporations who have a vested interest in keeping things as they are.

    If all the interested parties (Rehab corporations, Big Pharma, etc.) were truly interested in fixing people, they would listen to people like you two and your suggestions. They may or may not work, but they have to be more effective than some what comes from some suit in a cube, who’s main interest is the bottom line. If it’s done right, they could still make money, if that’s their main concern.

    At the risk of beating the dead elephant in the room (Would you like some mixed metaphors with that, sir?), I think when the profit motive is the primary driving force. everyone suffers except the stockholders. People like you get frustrated and discouraged, the addicts remain addicts, family issues become worse, and society itself suffers. For those of you genuinely interested in helping, then you must feel like you’re on that hamster wheel going nowhere fast.

    I certainly understand that people need to eat and make a living, and have bills to pay, etc. I am not arguing against that, at all.

    This is just my opinion and unlike apparently most people today, I DON’T have all the answers.

    But if you are only in it for the money, then maybe you’re better off selling used cars.

    Like

    Reply
    1. Victoria Post author

      Nailed it again!!

      I think A&D counseling is one of the few professions where you really do not need to actually be a professional – and you, Charlie, are a very good example of that. All it takes is intelligence, a willingness to observe and listen, and a desire to help. When one intervention doesn’t work, you try another. It’s a lot of trial and error, and meeting people “where they are”. Oh and the addict HAS to make material changes in his/her life, or all the counseling in the world won’t make any difference.

      What you DON’T do is throw lots of people into an institution, focus on triggers triggers triggers, shove religion down their throats, and tell them they are helpless to overcome their thoughts and behaviors. How is that, in any way, empowering?

      I think Gray and I need to start our own treatment program heh. Charlie, you can do the PSAs and ads for it, since you are now on your way to becoming a famous actor!

      Liked by 1 person

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s