As I approach the last year of grad school (is this real life?) and mark my one year at my current job I have lots of thoughts on working in mental health. Not in any particular order, here are 5 thoughts I have every single shift and every day at practicum:


1. Why is the world such a terrible place and why do terrible things happen to people? 

There is a strong correlation between adverse life experiences and prevalence of mental illness in a person's life. Honestly sometimes the things that I hear make me want to curl up in the fetal position because it just hurts so much knowing that someone has had to experience such difficult things. Sometimes I'm just at a complete loss. Like why? Why does this have to happen? Why does it continue to happen? Will we ever be able to stop it?

2. Am I helping? Like at all? 

One time one of my professors said "Therapy is such a crap chute sometimes. You never know who you help, if you help at all." I was actually very relieved to hear this, as it reflects my own experience for sure. Sometimes I get home from practicum or work and wonder if I did anything that mattered that day. It's not that I need to know for sure that I helped someone or that I need to be recognized for doing that, it's that it's important to me to both push and support my patients and my clients in the right ways. I don't always know what's right. Sometimes you just come home thinking you didn't do anything right that day and at best the world is no better off than before you came in. It's a sucky feeling.

3. What if this person doesn't make it? 

I think about this a lot. By "make it" I mean in physical sense and an emotional one. Working with eating disorders (the most deadly category of mental illness) definitely introduces the idea that some of our patients will die due to the extreme stress of the disorder on their bodies. But I also mean "make it" as in be happy, have a life you want that's not hijacked by anxiety or trauma or depression or whatever it might be. To be very honest with you, this thought is the one that disturbs me the most. I have to push it out of my head and just proceed as if everyone I interact with will make it, even though I know that statistically that's unlikely. I think this is such a big thing for me because I have a lot of fear around what my life would be like if I hadn't made it to recovery. I physically wouldn't be here, and even if I was I'd be just a ball of anxiety, depression, panic, and self-loathing, Or in other words not happy in the slightest and not the least bit satisfied with my life. Nothing I would ever wish on anyone and something I'll forever be working to avoid.

4. I just want to take you home. 

I think this all the time. Not about every patient and client, of course, but there are some that just tug at your heart strings. And it's not just kids either. This past school year I had a client who was older than I was and way taller, and yet I just wanted him to be mine to care for. This happens at work too. Sometimes I want to take people home with me because I feel like their families/support systems suck and I don't think their parents are even worthy of them. And I think I can do a better job supporting them. And sometimes it has nothing to do with their support system and it's just because I really love this patient/client because they have a great personality and I genuinely love being in their presence. And sometimes it's both. I think I have this fantasy that I'll take people home and everything will just be okay. Then I remember two things: 1. I can't even get myself to shower every day so I really have no business being responsible for other humans and 2. I can only give what I can give, and what I can give is enough even though I often want to give more. And I also know that doing this, even if I could, would likely not solve any problems.

5. Am I going to be able to do this?  

Kind of in the same vein as #3, I often wonder if I can handle this. I especially wonder this on the hard days or days where triggering things are happening. I wonder about my own recovery and if I'll be able to maintain it. How will the stress from work affect me? Have I worked my own stuff enough to be able to be present for others as they work through their stuff? What do I need to be okay doing this work? What are the indicators that I need to ask for help? And how will I do this and who will I ask? What are the consequences of ignoring my cues? While I'm at work/practicum I compartmentalize. If things start coming up for me I wall it off in my head and focus on my clients and patients. This works extremely well. The problem is I get home and kinda freak out cause all the levees break in my head. Over time this builds up. When I'm in the moment with people, this question doesn't come to me. It comes to me when I'm forced to be present with my own emotional reactions to tough situations. And sometimes this thought occurs when you just feel defeated and like nothing your doing is making any difference at all.

It's tough this field we're in. You never know if you're going to a get a day where things are going alright and the world seems like an okay place or if it's a day where it's just all gone to hell and we should just stop it somehow before things really get bad. Either way these are the questions I'm often asking myself.

Thanks for reading, friends!

       Based on a conversation from earlier today, I started thinking about the closet full of ghosts that all therapist's have. This ghost closet is conceptually similar to a skeleton closet, though not exactly. It's not really a skeleton closet in the sense that this is where all of our past bad deeds or moments of questionable judgment are kept. But the ghost closet is that space within us where we keep all of clients that we didn't get to say goodbye to, all of the clients for whom, for whatever reason, there wasn't a proper termination.

     My career so far has been short, (arguably it hasn't begun at all) but still I have several ghosts of client's that haunt me. I have moments where I remember these clients and remember that we never got to say goodbye and I feel this pang that makes my heart slightly fold in on itself. I don't have these moments so much that I am unable to be present or unable to connect with new clients and those around me, but I have them frequently enough to never really forget the clients the ghosts represent either. For me, these clients are in limbo; gone from my practice and from my physical world but nowhere near gone from my heart or mind. I find this discrepancy deafening. This phenomenon of the ghost closet often takes on physical form because we're art therapists and frequently left with the art work of our clients.

     As a student therapist I sometimes observe that I seem to feel things bigger than the professionals in my field. I just seem more sensitive, more likely to feel surprised, and more likely to feel in general. It's not that over time people learn to care less, they just gain experience with all of the potential outcomes of a therapeutic relationship with a client. Since I'm new at this, I don't have much experience, I'm only just becoming aware of what the different outcomes are. And every time one of them plays out it's usually the first time that's happened to me. Even in my inexperienced state, I know that clients coming and going without notice is par for the course. I know that this could always be your last session with a client. While I have internalized this, no amount of knowing that it could always be your last session prepares you for when you find out it actually was your last session.

     I feel like generally speaking I get really close to my clients. Yes, it's very boundaried and yes we're close in very specific kinds of ways but close is close. In order to fully connect with them I must be unequivocally connected to myself. This connection loop, that starts with me to myself and then extends to my client, makes you get close. We're basically in a trust loop. I trust me, I'm inviting you to trust me too, and to trust yourself while I trust you. These connections are powerful and raw, and when they suddenly end it's sort of tragic and maybe even traumatic. As the therapist in the loop I'm left with this feeling of un-finishedness, sadness, and grief. Yes, I can do my own work and settle my feelings as much as I can about the abrupt end, but there is some part of me that will always grieve these clients more than the ones that I got to properly terminate with. There's something about those clients that stays with me in this place that they can never move out of because our connection was still present, still live, when they left. Neither of us had time to properly tuck in our connecting parts and say our goodbyes.

  It's like holding hands with someone. When you're actively holding someone's hand your fingers are interlaced or your hands formed around theirs. When you let go your hand returns to a resting position. But what if one hand was suddenly just gone, if it suddenly disappeared? At first, the remaining hand would still be molded to the hand that disappeared. The remaining hand may search for the other hand, the newly exposed skin might feel a slight breeze. For me, this is what it feels like to not get to say goodbye. My "hand" is still in the position it was in when we were holding hands. And in some ways, it will always be that way. There's some part of me that will always be waiting for the other hand. There's some part of me that will always be wanting to plan letting go of each other instead of one hand just disappearing. Because I'll always be waiting, these clients don't live in the same place in my head or my heart as the clients that I planned to let go and planned to let go of me.

  So what do you do when you don't get to say goodbye? I cry. A lot. And I draw. And I find myself wanting to talk about it. I find myself wanting to tell my mentors and supervisors about my client and the work we did, about how it feels now that they're gone and about the hope that I have for them. I find myself wanting to sit in my thoughts of my client and be with them that way. I fantasize about expressing my anger to the person that represents the circumstances under which my client had to leave. I recite in my head all the things I would have said if I'd known it was our last session. And then I cry some more.

   I'm writing all this because I'm trying to figure out how to be okay with being vulnerable and authentic in relationships that are fairly unstable. I'm worried that if I can't learn to comfort myself and cope with the grief of unexpected termination then I won't make it as a therapist. I don't want to burn out because I never learned how to cope with not getting to say goodbye, because unexpected termination is a reality in the field we're in. So while I'm getting used to the reality that this is going to happen, I'm far from it not affecting me. It seems like the only thing I can do to keep myself balanced is to be true to all of these feelings when they occur. Acknowledge those painful, heart-folding moments and then spend some time remembering why it hurts. Don't expect to feel better and do learn how to hold that this wound may bleed for a while. I think I'll be more worried about myself  if I ever don't have a response to an unexpected termination than I am right now. Because if I don't care that someone's gone then something has gone awry. When I think about it like that I'm okay with continuing to work on this. My supervisor at school told me that if I'm feeling disappointed that the relationship is ending (or in this case has ended), then it was good work. There's rapport and connection there. So that's something to hold on to. It was good work. But I didn't get to say goodbye. I didn't get to package our work and review all of the gains. And I didn't get to convey that it was truly an honor to be with this client. And that's the part that stings.

 Hello everyone!

 So, Kenya and Tanzania. People keep asking me "how was your trip?!" It's so sweet and feels nice when people ask but I'm having a hard time answering them. I have so many answers to the question. I often find myself wanting to say "How much do you want to know?" or "How much time do you have?" or "Do you want the feel-good version or are you really asking?" It was everything. All the feelings happened. It was amazing, challenging, exhausting, fun, scary, incredible sense of community, deeply sad, inspiring, tiring, emotional, everything. You name it, I felt it.  This post will be like an overview of the trip and then subsequent posts will be more specific. My own processing of everything is still happening so the content and how I categorize them is likely to shift as I sift through my thoughts :) You have been warned.

  We did a lot of moving around on this trip. The longest we stayed in one place was 4 nights, most places we stayed for only 1 or 2 nights. We didn't stay in every place we visited, some places we were there for just the day. In Kenya we landed in Nairobi and visited Karen, Naivasha, Kibera, Namanga, and Amboseli National Park. In Tanzania we were in Arusha, Moshi, Dar es Salaam, and Bagamoyo. Some days we traveled the whole day but not many. Most days consisted of workshops in the morning and skill shares in the afternoon. Twice we worked children from the community. Workshops mainly involved the group from the states and the 6 Kenyan and Tanzanian partners.
 Some of the skill shares were bookmaking, dyeing with natural dyes, printmaking, and break dancing. Some of the workshops were mandalas and engaging with art, violence against women, grief and loss and creative writing, intro to dance therapy...there were several more but those are what come to mind right now. 

At night we would go to dinner and after dinner we usually hung around the hotel and talked, drank, and enjoyed each other's company. Sometimes people would turn in early or want to have some alone time. I found myself doing both. I had a very difficult time emotionally keeping up with everything that was happening. I tend to be a deep processor and need the time and space to do that, but usually that was just not something I could fit in. It was a challenge to manage everything. I was going a lot of writing and a lot of drawing. Looking back I don't think I was really processing though, I think I was just trying to contain it all so I didn't have an avalanche of epic meltdowns.

Whether you choose to or not, you get really close to the people you are traveling with. I have found this to be one of the many gifts of this trip but also one of the things that made me have a really hard time. I made several friends who I am really excited to be colleagues with and see over the years at conferences or trip reunions and stuff. There is definitely something to be said for a shared experience of a trip like this one.

 Well, I think that's what I have right now. There will be a series of posts on the trip so follow along if you're interested. I'll end with some pictures :)

Somehow this girl and I managed to almost miss several flights over the course of the trip, including our very first one from STL to Chicago. I'm still not sure how we made it all the way there and back. 

Great Rift Valley 

Great Rift Valley 

STL girls at the Great Rift Valley 

My first daytime view of the Indian Ocean from Dar es Salaam, Tanzania. 

Bagamoyo, Tanzania 

Due to her youngest sibling status, we called her baby Hannah. Best anthropologist I know! 

Victor. 

Beach photo op. Love everyone pictured. 

Grace. A force to be reckoned with, easily! 

Just trying not to lose our boarding passes. 

Too much fun at the airport and on the plane from Dar to Kilimanjaro. 

Namanga, Tanzania. This is a really typical picture of us. 

Walk to dinner (roasted goat, it was delicious) in Arusha. 

Amboseli National Park 

Amboseli National Park 

  So for the last two days of the trip there was an optional safari. Not everyone from our group took the option but many did! Here are some pictures and stories from that! We saw lots of animals, here some of my better pictures. These are from Amboseli National Park in Kenya. It was absolutely beautiful there. I've said this before (and probably will continue to say it) but the pictures don't do it justice, the capture about 2% of what the actual experience was like. Bundi, our driver, did an awesome job driving us and finding animals. He is really knowledgable and I enjoyed listening to his factoids!

These are elephants! (From really far away)

This guy turned and gave me a great shot! 

Elephant family! 

The elephants were amazing and so fun to watch. It felt almost magical to be so near them.

The giraffes were very cool also. They seem to very curious animals. When we pulled up they all got very still and just kind of watched us for several minutes. If you look closely on the left you can see a little guy peeking out from behind his mom/dad. He was my favorite! 

This baboon had a little baboon baby, he was sooooooo cute! 

This baboon baby was slightly older but still super cute!

Hippo!

I don't remember what this is, but I thought the face he or she was making was hilarious. 

Ali in her Safari muumuu and hat, ready to see some animals. 

Katie and Ali cracked me up pretty much the whole time :)

And the fierce lion made me laugh as well. 

Ali spotted a lion. 

Meeting this one was one of the highlights of the trip! 

We rocked the back seat! 

Partner in crime (: 

Victor came on the safari too!

  And finally, here's Kilimanjaro. It is difficult to see but it's there. So the clouds in the center of the photo about cut the mountain in half. That teeny strip of white in the center but near the top is the snow-capped peak. That safari was amazing, we had so much fun and it was a really great way to end the trip. More about the beginning and middle of the trip in later posts!