Thursday, July 26, 2012

3 Reasons to Be Tired

I can tell I am getting tired.  It seeps into my body, my mind and my soul.  This is part of getting ready for vacation, which now is just a week away. To go on vacation it is necessary to be tired.  A vacation should be earned.  For me, it is difficult to just walk away because you can; you have to be tired.

So I am getting tired.

It seems like many of my colleagues are tired also, and a bit scared.  They can see that the landscape is changing.  This whole health care delivery discussion makes everyone wonder what's going to happen.  It is reasonable to assume that those who will be making the decisions will have no idea what they are really talking about -- on a therapist to patient level.  The decisions will be based on money.  Those of us who still bill insurance companies for our services have already seen that the way insurance companies will cut costs is to pay us less. 

The other way will be to not pay us at all.  The model that most psychotherapists use, seeing people in their office for about 50 minutes at a time, once a week, was created about a hundred years ago.  It hardly fits today's world.  Two things are happening.  Well trained, Ph.D, or M.D. therapists are being replaced by Master's level people who are paid less.   Also, technology will enter into the mix.  People will be treated by text messages and Tweets. How much does it matter?  I think it does, but it is very difficult to demonstrate. I am the best therapist in the world and I only help about 62.347% of the people I see.

All of this makes everyone discouraged, and tired.

When I'm rested and on the top of my game, doing therapy is challenging and fascinating. When I begin to get tired I can feel the resistance.  I can still deal with it, but it is there.  What happens is I feel badly when I open the can of worms and really see what's in it.  Today I was working with a guy I have been seeing for about six weeks. I like him.  He is bright, interesting and came to me for anxiety problems.  I am good with anxiety problems, especially if they are , you know, anxiety problems.  But they are not always just anxiety problems, very often they are more than that. It can take a while to find out.

Today, I was doing what I do, which is when someone with anxiety is still just as anxious even after I have sprinkled the first wave of magic dust on them, I probe a bit to find out what' s going on. Now, this is a guy I really like, as it is with most of the people I see.  When I like them I don't want them to be too fucked up.  But I still have to look under the rocks and see what's ticking.  So today, I looked under the rock and found out the the guys isn't just anxious, he's full of self-loathing and has cut himself.

I was tired.  I didn't want to find this out.  I want him to be OK.  I wanted it to be easy.  I can handle it, but then I'll go on vacation.  Now I have to do things to make sure he's OK.

It's not that I'm complaining, because this is what my job is.  It's just that I'm.......

Tuesday, July 17, 2012

I am OK -- but..

I am OK.  In fact I am doing surprisingly well. This has been a great summer.  I am in good shape and healthy.  My eye is better, my knee is better.  Nothing really hurts.  I have been very active kayaking, biking and chasing my grandgirls -- only one of whom can actually walk, so it's not that hard -- but the one who can walk loves to run away.

I like hot weather, so the summer has been good to me.  We go off to the beach house and play.The kids have been coming and bringing their kids. Friends have been coming. We discuss how the world is  falling apart while sitting in great comfort.

Then I go to work and things are different.  but that is the nature of what I do.  People very rarely come to me to tell me how happy they are, or how excited they are about the interesting, creative, fulfilling things they are doing.  That happens occasionally, but that means it is the last session.

But I have been doing this for years.  I can deal with depression, even terrible depressions.  Anxiety; hey, everyone I see is anxious, also I can be helpful for loss, loneliness, confusion, stress, relationship problems, addictions, even violence. Hey, let's talk about it. My kind of therapy at least doesn't have side effects.  It won't make you constipated or gain weight.

But you know what upsets me.  Dealing with people who have chronic, physical pain.  I mean pain that has lasted years and comes from degenerative diseases.  Diseases that not only resist treatment, but that the treatments for them seem to create other painful conditions.  The drugs lead to passing out, or digestive disorders or kidney failures.  Pain raises blood pressure, the drugs for that causes dizziness, people fall down, cut themselves and go to the hospital and pick up a staph infection. The antibiotics for the staph infection cause colitis, which leads to a colostomy.  But still the pain, from the degenerating bones, or the pressure on the nerve from the back injury, or whatever it was that began the whole process goes on, and no one can really find it, and if they find it they rally can't do much about it.

Part of why it bothers me is that I am getting older, my friends are getting older and my clients are getting older.  For me, I can no longer run and jump.  For me, who played basketball for 25 years with the same group of guys it is a loss.  But I can cope.

What i know is that more is coming.  More of my friends have had knees replaced, hips and shoulders too.  They are on all kinds of meds because this or that number comes up too high. I take one little pill. Other friends have stents in their bodies, or have difficulty getting out of chairs, or even, are dead already.

So far, most of my friends and family are basically OK.

I plan to be immortal, until I am dead.

Monday, July 09, 2012

Back to work

The summer will continue, but for now, I am returning to my office.  I did have a marvelous week at the beach house.  I did get to go to the beach with my grandgirls, although Elmo stayed at the house.  We threw rocks into the waves, we sat on the edge of the water and made splashes. I got to see my children be parents, which is kind of weird, but certainly an experience, and it made me very happy and  a little sad (becasue I don't want to be old)..

Now I am in the re-entry phase.  I picked up my messages and made several phone calls.  I have a lot of appointments this week before I get to go back to the beach.  Some of them have already canceled, others have left messages seeking an appointment and they will will the openings.

Also, I have been perusing some of the blogs of my colleagues.  Most of those are done as kind of marketing tools.  They usually try to spread some psychological wisdom around the Internet.  They give suggestions about how to be active in the summer, how to get people to listen to you, how to be more confident, how to daydream creatively, how to daydream destructively; in general how to live your life in a better, healthier way, if you have any time left after reading how to do all those things correctly.

But this blog is not like that.  As you know this is the anti-marketing blog.  This is where I tell you that I have a very busy week ahead, but there are a few people, a real minority, like 15%, that bother me, and that overshadows my thinking about the folks I am eager to see.  Most of the people I see are working hard to change their lives.  Many are struggling against "strong headwinds." as our President likes to say about the economy.

But there is this small group of patients are really nuts, and they ain't going to get much better, and they weigh me down.  They are the ones who make phone calls while I'm away.  They are bad with boundaries, they are bad with time, they make bad decisions and they don't take responsibility and have little insight, and they talk and talk and talk.

I am sure every therapist, especially if you have been in business for a while, has a bunch of these, but they don't seem to talk about them on their blogs.

So, put on a smile, as it helps your neurology, develop a positive attitude, enjoy the summer, be nice to your friends and family, eat only food that is good for you, don't go into debt, exercise regularly, sleep well, don't worry needlessly, stand-up straight, breath deeply, meditate once in a while, think before you act, and break your addictive habits.  And don't call your therapist unless you need to change your appointment time.

Sunday, July 01, 2012

Summer, again, briefly

Wow, it's been a while.

That's becasue it's summer and there is so much to do.  so much to do without thinking about it.

Right now I am officially on vacation for a week.  Before this I was working days and then taking off whenever I could.  Here in New England, when the sun comes out you had better be there because it all ends quickly. It doesn't matter if you're out to get in the water, hit a ball, ride a bike or just take a walk; the time is short.  We don't get Spring, except for about three days.  It goes from 42 degrees and drizzle to 87 degrees and heat.

Work in the summer is different.  There are fewer patients but they are nuttier. Everyone half same takes off and gets outside.  The fragile ones go into crisis. It's the heat, the moon, the outside.  It's the alcohol, the half naked women, the resentments.

The day before I was leaving I get an emergency from someone I had not seen for three years. Falling apart, laying on the floor of the H.R. office crying.  The next day I guy I hand't seen for four years comes to my office ten minutes before my first appointment.  He needs to talk.

"Some people claim that there's a woman to blame." And they are correct.

But tomorrow the Grandgril comes, and after Elmo, I'm one of her favoirtite guys. Let's go to the beach.