Quasilaur’s Blog

I’m closing in on my first month without a job. This is part of a three month, intentional exercise in finding out where my next employed step will be. Yesterday, I found myself pondering why it’s so frustrating trying to be a social worker/therapist in Seattle. Granted, I’m still finding my way around Seattle given I’ve only been here for 4 yrs, but this is a bit of what I’ve found so far.

There are a lot of people in private practice in the helping professions. Not only do we have the University of Washington, that turns out MSW’s from not just one, but two campuses, but we have a number of other universities and professional schools that offer Masters degrees that can lead to counseling positions. Up until recently, Washington did not the require licensure to be in private practice (though the Registered Counselor issue is soon being rectified.) I happen to know of one prominent local woman that, last I checked, had no verified credentials listed on the Department of Health license list, but yet she offers not just counseling and therapy, but also classes and personal sessions on more intimate topics.

More than a couple of my former clients at both the hospital and with the mental health court would tell me that they had found a naturopath that could treat their schizophrenia or bipolar disorder. While I do not discount that lifestyle, dietary and supplemental changes can have a positive impact on mental health, usually by the time I’ve met this person, they’ve gotten themselves in some serious trouble that sends a clear signal that something wasn’t working.

I actually love going to my naturopath (ND) as that I’m more interested in getting wellness tips on a regular basis than seeing someone once every two years (or more) for an infection that’s not self-resolving. The problem with ND’s is the same problem I find with many of the people advertising as therapists in the Seattle area: how do you distinguish from the grounded, holistic, respectful of conventional medicine/practice individuals and the flighty, fanatical, anti-establisment practitioners? Jon reminded me of an ND he saw once a few years back who went on an anti-semetic rant regarding 9/11, which was a stark contrast to the professionalism and level-headedness of my ND.

Both of them were Bastyr graduates, if I recall correctly.

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Now, not just anyone can be a counselor

By Michael J. Berens

Seattle Times staff reporter

One of the most loosely regulated health-care professions will be abolished and more than 18,000 people stripped of their counseling credentials as part of legislation signed Tuesday by Gov. Christine Gregoire. Eliminated will be the “registered counselor” profession, which state legislators created 20 years ago in response to reports of patient abuse by unlicensed practitioners. But a hastily crafted law required applicants to do little more than pay a $40 application fee and attend a four-hour AIDS awareness class. The state ended up giving the credential to high-school dropouts and even to convicted sex offenders.

No other state has registered so many counselors under such scant guidelines. As a result, Washington has been a haven for sketchy profiteers of every type — from miracle healers to psychics — who have bolstered their credibility as state-sanctioned counselors, a 2006 Seattle Times investigation found. The new legislation creates eight mental-health titles, each carrying progressively higher standards for education, supervision and training. Current registered counselors have until July 1, 2010, to qualify for one of the new regulatory titles through the state Department of Health. (more…)

Today I got a mass email from a case manager w/ my agency whose program was cut, and he declined the offer of a FT position. He welcomed people to keep in touch w/ his private practice website.

So I went to the website. Clicked on “credentials” and find that he claims to have a Master of Arts in Counseling Psychology from 2006 (shit, I graduated in 2004!) from “Mars Hill Graduate School,” which is no accredited school I’ve ever heard of. I go to the Mars Hill Graduate School website and find they are still in application for accreditation of their MA in Counseling program. He’s got a registered counselor number.

Do you know what it takes to be a registered counselor?

Go ahead, guess.
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I had every intention of sitting down today and writing something inspirational.

Since I’ve been out of the “write a six page post-a-day” club for awhile, I find that coordinating my motivation and thoughts in front of a keyboard is a little tougher than it was 4 years ago. I guess I’ll conveniently seperate my “most frequent thoughts” and give y’all a brief capsule as to my day-to-day.
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I am a social worker. I have a degree and years of study, and now I’m building up my practice experience. My identity is not totally wrapped up in being a social worker, but it’s so much of who I am that I’ve adopted the personal motto, “I’m here to help.” I can’t seperate my professional knowledge and reasoning from my personal life. I can, however follow the NASW’s Code of Ethics and good common sense by leaving my professional, therapist persona at work, and being just me outside of the work place. I have come to realize that the difference can be difficult to discern when I pull out my professional expertise in a non-professional setting. If I see someone exhibiting dangerous behavior, or if I’m concerned about someone and I’m picking up some warning signs that in my professional life, signal trouble, I will say something. The difference, though, is that outside of the work place, my job is not to be someone’s therapist. Ethically, I cannot be the therapist of just any random person I choose, especially people I know. I’m just a concerned person w/ a bunch of knowledge that other people outside of my profession might not have. So that means that I don’t always say things therapeutically, or approach things in the “professional way.” This is because I hold myself to a different standard outside of work. It’s almost like a costume that I take off and put on again. Unlike a priest or a pastor, that is expected to live their profession 24/7, my profession is 8:00-4:30, M-F, except for holidays. I’m allowed to be a fallible human being, contrary to what some might think, in my off-hours. That means I’ll wear sexy clothing, use curse words and occasionally say-the-non-therapeutic thing.
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I’ve always been a person who thrives on creativity. I find my creative energies, that whimsicality I’ve always known, to be waining in the tide of khaki and pink, with sensible shoes and no-nonsense attitude. My daily worklife charges me with crushing the realities of others, in supporting the involuntary medication and paradigm shifting charge of a state psychiatric system. We’ve all heard tale of seers and gifted ones that if transported from the pre-industrialized world to our world would be automatically labeled schizophrenic, judged and left to struggle. Even in the much-beloved Christianity of America, the visions of John or Daniel are venerated when deep in my little, Thomas heart I can only believe that they were madmen, very imaginative, or at least professionals in hyperbolic metaphor.

There must be a rational explaination for everything.

I can’t help but see the irony in my love of images of fairies (in fact, I’m wearing a fairy t-shirt right now) and living a daily reality that would so soon put Tinkerbelle to death. (Clap your hands if you believe in fairies!!)

My job requires me to submerge the fantastic, odd and ecstatic parts of myself in the interest of curbing those chaotic energies in others. While that was never truly my interest or aim in getting my job, it’s a necessary hazard being that what tools I have now are the best I got in a system that is so unredeemably broken. All that’s left to make an iota of difference is to get them while they’re young in the hopes of pulling them towards pro-social and healthy outcomes. It seems that once a person with severe and persistent mental illness is left to themselves, alone to find their way — and given a good amount of time to fight it on their own — it’s too late for any of the piddily public services to take hold and have a lasting, redeeming effect. It just seems that by the time these guys come to my ward, even just after their first arrest, years after their first psychotic break, I just wonder what could have happened that would have given them a better chance for the years to come. After eight months, I know most of the men that come through my ward will be back, and likely just as bad as when they first came in, if not worse.

Perhaps I should just put it simply: I hate my job.

It’s not because of the patients, or even the staff. Mostly, it’s because of the system that is so broken that where I work is the last dumping ground for society’s problem children. Many of the people coming through lack the community support (public mental health centers, community programs, healthy friends and family, jobs) to keep them healthy and out of the correctional and mental institiutions. We’re putting tiny bandaids on gaping, festering bullet wounds and shoving them back out into the night. These people are coming into the hospital at a rate so fast that by the time I sift through their demands and incoherant babble to find their basic needs, they’re catapulted right back to the jails for another court appearance. The basic paperwork I have to fill out for their admissions are barely completed by the time they move to another ward or their time at the hospital is up.

And the saddest thing to me is that one of the most common trends among these men is the complete lack of meaningful, healthy, stable human interaction in their lives.

By the nature of my work, I’m a destabilizing influence that only by luck transforms their lives to the better.

Or at least, that’s how I’m feeling lately.

I think I know more clearly why I would prefer to work with youth. It seems that if only I could convince some of these young people that stable, healthy, supportive human interaction is possible, than maybe they would continue to seek that out in preference of less healthy coping strategies.

Part of this is burn-out, and I’m long overdue for a vacation.

Truthfully, though, I really desire to make my current rate of pay, at an organization closer to home, where I work with LGBT youth, do counseling and social work, and make a positive impact.

The grass is always greener on the other side — but I truly believe that a different job would enable me to be a bit less banal.

Related link (all via BoingBoing): SAMHSA

What takes up a greater part of my mental real-estate these days is my job. I happen to think I have a very interesting job that has LOADS of implications in people’s lives, so I thought I’d share. My job title is officially, psychiatric social worker. It means that I have an MSW, and that I work with psychiatric patients at one of the largest state mental health hospitals in the nation. Even better, I work on the Forensics unit. This means that most of my patients have legal charges pending and are there for a competency evaluation (and sometimes mental state at time of offense) and competency restoration. The rest of the few that come in are people who come in for evaluation for civil commitment after their criminal charges have been dismissed.

Following so far?

What is competency restoration? It seems that in my job, if there is ANY job to do, there seems to be a law suit or government agency (because of a law suit) requiring that particular job to be done. It seems that through the years, someone decided it was unfair for a person of questionable mental state, who could not name the members of the courtroom, let alone, assist their attorney in their own defense to be taken to trial for their alleged offenses. (At this point, I’m just going to clarify that I’m not going to talk about NGRI - Not Guilty By Reason of Insanity. I work in Competency Restoration and on an admission ward, which means that my patients have charges pending OR dismissed.) So in order for the case to proceed, a person of questionable mental status (or in some cases, an attorney who wants his client’s mental status to appear questionable) gets sent for a period of 15-30 days (depending on misdemeanor or felony) for evaluation for competency (and usually mental status at time of offense). After that, if they need more treatment, they are sent for a 90 Day Competency Restoration, in which the patient gets medicines, 1-1 therapy, recreation and classes that help in the patient’s ability to work with their attorney in their defense. And just to get your civil libertarian panties in a bundle, many of these guys… MOST of them, come with a forced med order. This means that the hospital has the right to administer medications to the patient against their will. In addition, most court orders I read specifically state that the right to a speedy trial is WAIVED. These guys are in limbo while on my ward. They are still detained and in a high security facility, they still have charges, but as much as a year can pass in the hospital before the court ultimately has to dismiss the charges. Meanwhile, when beds at the hospital are full, the patients have to wait in jail until a bed is free.

The range of cases I get are between people trespassing in a public park in the early morning to a single repeat offender with charges of First Degree Rape and First Degree Murder (with an additional 4 other felony charges relating to the crime). My patients range from people talking in word salad (gobbledy gook nonsense that’s hard to fake) and clang associations (sort of rhyming loosely strung together phrases/ideas) to people who will quite honestly, calmly tell you in the most earnest and pleasant way, “Oh, I know who the judge is, he’s the antichrist.” Then there are the occasional malingerers - who for whatever reason, react and interact in a way that is to make them appear much more sick than they actually are (if they even have psychiatric issues at all.) There are young and old, healthy and strong, people who come in just after their “first break” and people who have been in and out of the system since they were born.

[I deleted a couple paragraphs that go into some of the nitty-gritty stressors, that will be another post elsewhere.]

This is my first social work job after achieving my MSW degree in 2004, and it’s teaching me a lot. I love to share what I do. But man, writing this post has made my head pound. I think I need a vacation.