The Day After

Now it’’s Thursday, after the Tuesday which was the last day in my office, except for cleaning out the draws.

Tuesday was much more difficult and complex than I thought. I had a full day of appointments.  It was my last meeting, as a therapist, with all of them.  It was my last day of being a professional, in that capacity, after forty-three years.  

Two days ago I was talking about the frustrations, about how I often felt that my job was a lot like having to redirect a tide that has been coming in, every day, for years, over the same path.  There was just so much I could do to change to constant flow of the water, the moon and the earth.  There is also the realization that those forces continue whether I am in my office or not.

Today, the day after, my feelings are much different than I had expected.  Instead of that frustration mixed with relief, I feel much more a sense of loss, mixed with satisfaction.

Each hour I said good-bye to someone I had been intimately involved with ( in a professional way, of course) for anywhere from six months to twelve years.  Two of them I have actually known for almost twenty-five years, as they have returned to visit me through several life changes.  I know the names of their parents, children, lovers and friends better than I know the names of my aunts and cousins.  We have been together through losses, tragedies, addictions, bad decisions, distorted thinking, and serious illnesses.  We have also been able to achieve marvelous successes, in recovering, in business, in relationships, in finding ways to put their lives back together.

During the past two weeks I have said good-bye to my last ten patients.  It is very gratifying to say that they all are doing well.  Only one of them requested a referral to another therapist, which was fine.  But the other’s, even the two who are completely nuts  

(diagnosis code:WOW) feel ready to take on the world on their own.  And they are.  Three have new, better jobs, two have moved to better places and feel secure, two are in new relationships, one is getting married and one is pregnant.  Marvelous stuff!

Don’t let me mislead you here.  There were dozens of others who I have referred out, or let go over the last two years who will not do as well.  They are part of the frustrations that haunt me.  The ones I stayed with until the end are the ones who I knew were doing a lot to pull things together.  

The point I want to make is that while there are still huge problems in our society, and worse problems in the rest of the world, yesterday really made it clear to me that we, as a species, are social creatures.  We live better, feel better, and do more when we feel connected to other humans.  That makes up a large part of what I did for people: I was there for them.  They knew that. I understood them, as best as I could. I didn’t judge them. I helped explain them to themselves, and I tried to nudge them in a better direction. For many of them I was the only one who ever did this for them.  Many had been pushed around, neglected, demeaned, ignored, abused, pressured, rejected and worse.  

It was their responses to me that kept me doing this for over forty years. I know I received so much for almost everyone I saw.  Most of the people I saw came to trust me.  They were able to tell me things that had happened to them, or just about the thoughts that ran through their minds Things they had never told anyone. I took that as an honor.  It was a great feeling to be granted this special privilege.

I am not a religious person.  I do not expect to experience a great spiritual awakening. I am very comfortable not having complete explanations for things, yet knowing that somewhere there is a cause for every effect, and that someday it may be made clear and understandable.  I don’t believe in uncaused (miraculous, paranormal) causes.

I have listened to the stories of thousands of people.  I have seen the rich and poor, and everyone in between.  I have seen geniuses and some who take a bit longer to understand things.  I have seen people of all races, creeds, national origins, sexual proclivities, and different levels of power. I have seen many people who have very unique beliefs.   

        I have come to some conclusions.  The most important one is that their is no intrinsic way to rank order who is worth more, or who is more important.  Money and material wealth are clearly false goals.  There is no real meritocracy.  Every soul, every spirit, every mind has the same value. We are a species who are both blessed and cursed by being able to wonder why we are here.  We are all here, and despite the many advances in medicine and science, at some point, we will each be gone.  It is up to each of us to find our place in the world, to try to figure out what we feel is right and important. We each have to do what we need to do to stay alive, stay connected, find some pleasure and find some satisfaction.  

Its not an easy task.  It is a life long process of trying to get it right, without having any idea of what “it” is. Usually we find our answers with other people, in mutually caring relationships.  We do this first with people who are very close to us, and then with others, in our communities, in our societies and in our world.

Now, like all of my former patients, I am movin’ on to the next stage, eager to see what kinds of interactions that will bring. Change is difficult, but it can also be exciting.

Last Day Tomorrow!

I wrote this on Monday.
I see that it is a lot like my last post.  Obviously, that's the way that I feel, so I will post this here, now:

This Tuesday will be the last day that I meet with patients in my role as a psychotherapist.  I have been slowly working my way to the end after doing this for over forty years.  I have been closing the practice in slow steps so this ending does not come as a shock or a disappointment.  It is more of a “finally, it’s over.”

I have spent over thirty of those years running my own practice in a mill city in Massachusetts, less than an hour from Boston.  It is a fascinating city with a long history.  It is a city with a constantly changing population of immigrants, who move through a very stable core of long time families.  The city is surrounded by suburban towns which range from working class bedroom communities to towns filled with very wealth families and some large estates.  

During my years here I have seen everybody. I have seen some of everything. It has been a fascinating time.  In many ways I feel that this was what I was meant to do.  From the feedback I received over the years I was reassured that I was good at it, and that the work I did was successful and appreciate.  It has been gratifying that since I have announced that I was not beginning with any new patients I have received many calls from patients I had seen who told me how much I helped them get through difficult times in their lives.  I will certainly miss that.  Of course, there have been many people who I have not heard from.

Another thing I learned through the leaving process was how exhausting and stressful the job was.  I never really felt that when I was in the middle of it.  I remember that for years I would see thirty-five to forty clinical hours a week, and at the end of the week I would be happy to take a break.  But I always felt stimulated by the work.  I always had things to think about, interventions to try, strategies to plan, and puzzles to solve.  I didn’t realize until I had reduced my workload drastically, how totally absorbing and tiring it was.

Some of that of course, is due to my getting older.  But more I think is due to seeing that once I was able to really put the weight of it down, it seemed so much heavier to pick up again.  When I was in stride, and carrying it with me and thinking all the time, it seemed to just flow.

There is still  down-side that I feel more acutely now that I am finishing, and that is the frustration of how difficult the whole process is, and in many ways, how little gets accomplished.  Yes, I was helpful, and many people, over  time, were able to change aspects of their lives to either learn to cope better, change some of their circumstances, or learn many new skills about how to run their lives and make decisions.  But, and it’s a big But, there were so many aspects of a person’ life that I could not touch, change or influence in any way.  So much of mental health difficulties are intertwined with other factors, A person’s genetics, poverty, loss, some kind of victimization, racism, some kind of illness, crazy families, economic pressures, bad jobs, bad bosses, or just some random occurrence in life: luck.   Often it was two three or four of those things happening at once.

And now, I spend more time with friends and family.  I try to spend more time just doing more of the things that are interesting and fun.Still,  I find I can’t get way from that feeling of frustration. I feel that those underlying causes of psychological and emotional distress still surround me.  It’s not just the craziness and tragedies that I see in the news, I see it in my friends who are anxious, in their kids who are struggling, in the city schools that we visit, in the neighborhoods of the city where I worked for so many years, and in almost every city around here.    And what makes it more striking, is that Massachusetts is one of the most prosperous, healthiest, best educated and well governed places on earth. I know how bad it is everywhere else. 

We keep pushing the rock up the mountain, and it keeps rolling back down.

Seeing all this still bothers me, especially with the current craziness going on politically.  In my youth, in the sixties, I felt we were really taking the right path and making a difference.  I do feel that things have moved in the right direction, and that there are a lot of good people who try and who care.  Yet, change always comes with a backlash.  And now change is constant, and change is always hard to accept.  It affects everyone differently. Often, the resistance is powerful.

It’s a shame.  The rock is still there, fifty years later.  The mountain is still there.  I had hoped, especially with all of our new technology and new knowledge, that more of us could agree on some longer lasting solutions.  I had expected that by now we would have broken down the rock and leveled off much of that mountain.  

Sad. I don’t know, Maybe soon.  Not holding my breathe. But still trying. 

2011

So, It's a new year.  What are you gonna do?
Lose weight? Drink more? Learn to SCUBA dive? Bet on nothing but Black and #27?

This year is going to be different for me.  How?  I'm not sure yet, but I am being told that it's time to make changes.

Change come with difficulty.  I know that.

All I expect to do is change one day a week.  Soon, the government will send me checks so I won't have to work so hard.  But what else is there to do? That's the question.

I can spend the time that I  gain from not working to stretch, exercise, cook well, eat right, and get more rest, so that I can live longer, and have more time to stretch, exercise, cook well, eat right and try not to die.  That doesn't seem too exciting.

Or maybe I will through caution to the wind and eat a lot of bacon-cheeseburgers and go heli-skiing until my knees fall off.

But I have been reading that doing and learning new things is the best way to rejuvenate my old brain and get it to perform better and longer in many different areas. So maybe, using this one a day week, I can learn to play the banjo and go to school and get a Ph.D. in genetics.

At least it will give me more time to write a blog.  Have to keep my mind open to all possibilities and see what emerges. 

changes

I sat with Bob and we talked about how he has not sent his resume out. It has been six weeks. He almost did it. He is waiting for his girlfriend to review it. He knows he needs a better job. He's been stuck in this one for five years, going nowhere. He could probably get a better one pretty quickly too. He's good at what he does.

Alice should move out of Frank's apartment. They were roommates for a couple of years. Then they were kind of more than than. Then Frank met Betsy and she moved right into his room. Now Alice and Frank are kind of friends and everything is awkward. If she moved out she could see more of Paul, who was once Frank's friend, but isn't any more. But Paul likes Alice, so they meet at the coffee shop. If she wanted to she could move in with her sister....but she doesn't.

Me?? I've been doing the same thing for almost thirty years. Things are getting more diffiuclt, with all of the forms and regulations, and diminished reimbursemnts. Sometimes this almost feels like just a hobby.
I've been thinking I ought to do something else, or at least learn about something else. I've been thinking that for about eight years.

This week I signed up for a six week course. In six weeks my whole life could be changed.

In six weeks I may be a gastroenterologist.

No, that's not the title of the course. I'd better check-- but whatever it is, it's new and different.