Sunday, October 8, 2017

Professional Identity Thoughts

This past year has really made me think about my professional identity and future career. I always used to say "I never want to be a therapist! I can't imagine having to listen to people's problems all day." But now, as I enter my third year of supervised clinical work, my perspective is completely different.

My first year of clinical work was not very fun. I worked at an outpatient community health facility that serves low-income people. Supervision was less than ideal, student interns were very under-valued, and client turnover was huge. This first year basically reinforced my idea that clinical work was not for me.

My second year of clinical work was completely different. I worked at a state hospital in a long-term psychiatric unit. The majority of the people on my unit had schizophrenia and are often treatment-resistant (meaning they do not respond well to anti-psychotic medication). I did both group and individual therapy. All my individual therapy clients were diagnosed with schizophrenia. I was supervised by a psychology intern weekly as well as informal supervision from the unit psychologist.

This year really changed my view of clinical work. First of all, it was the first time I really experienced formal, individual therapy with people diagnosed with schizophrenia. It was very challenging, eye-opening, and rewarding at the same time. As I continued to gain experience, I realized my own strengths as a clinician and my ability to effectively work with individuals with schizophrenia. I feel that working directly with this population is not something every clinician is good at, or even wants to do. Second, I learned how much progress can happen in a full year of consistent therapy. When it got closer to my year as a practicum student ending, I knew I couldn't leave. So, I spoke to my supervisor and figured out a way to stay and continue seeing a few of my clients. I decided to do this because all of the clients I started therapy with were still hospitalized. I figured I could continue to build the progress I had seen while learning clinical skills along the way. The course of recovery from schizophrenia can be a long one, and I feel very grateful that I can continue to help a few people I started with to build their growth.

I think I enjoyed it so much because of the clinical presentation of the clients and the setting. I had experience with schizophrenia in the past, but this was in psychiatric rehabilitation programs, which can be pretty different than formal therapy. Also, I really enjoyed the inpatient setting. It helps maintain consistency with sessions and rapport-building with clients. And I enjoy collaborating with professionals at the hospital. Some of the nurses are really amazing and I love getting their perspective on clients. The psychiatrists are really good and the chair of psychiatry is doing a great job building the department. And there are several psychologists who are amazing and really care about the clients. Finally, there are some great techs who have their own views of the clients and welcome collaboration daily.

The culture of the hospital is different than other places, too. A few of the clients (sadly) have lived there a long time. Some of them between 5-10 years. Most of them want to get out, but sometimes people want to stay there forever. While you are there, you really get to know the clients well. Certainly the people I have met with for therapy, but many others through groups and informal interactions. It is amazing to get to know people there and really experience how amazing people are underneath their shells. I have had such a great experience here that I am seriously thinking of being a full-time clinician. I hope to do this and still be involved with research. I think staying in touch with research is so important to be an effective clinician.

Well, those are my thoughts for now...

Friday, February 3, 2017

Clinical Work is a Challenge

Today I am thinking about how challenging clinical work (and being a Psychologist) is.

Lately I've thought about the intimacy of individual therapy specifically.  I currently work in a long-term inpatient hospital, so most individuals are in the early stages of their recovery. Many have not accepted that they have a mental illness, and are doing their best to disentangle their experiences. So, when clients share their experiences with me, I feel very fortunate to have gained a level of trust that allows this.

The experience of psychosis seems very scary and can include extreme paranoia and hallucinations. When these symptoms aren't controlled, they can take over your whole being and be very overwhelming. I can completely understand a person questioning whether or not this experience is a "mental illness" or if it's reality. If something so powerful and compelling to surround your world, it is your experience, which is your reality. I think being in the system focuses a lot on labels, which are very difficult to comprehend in the early stages of recovery. Labeling your experience as a "mental illness" has its pros and cons, and I think each person has the right to interpret their experience however they want.

I really love doing therapy with individuals diagnosed with schizophrenia. Last year, I really hated therapy (I think this was because of the setting I worked in) and a few years ago, I hated clinical work (I think that was due to lack of experience and other factors). This year has made me question (again) my career path. I'm starting to feel like I need to do clinical work in some capacity. I feel like my skills will be wasted, and they could be used for good. I love research, too, but I need to figure out how to balance the two.

People often ask me how I became interested in schizophrenia -- well, that's a complex question with many answers. One of my answers is because I really do love it, and I think my strengths as a clinician fit well with this population. Also, there are unique challenges that accompany the diagnosis, and I believe being a schizophrenia specialist is valuable. So, I've put a lot of energy over the past 10 years in learning and working with this population. Maybe this is why I've felt overwhelmed at times while at the hospital, or after a long day of clinical work. So much of my energy is often devoted towards my specialization, and this year I've really had the opportunity to put these skills to the test. I really care about the people I work with, and hope the best for them. Maybe I put pressure on myself. But that's OK. I want to live up to my potential and really help those in need. Everyone deserves to live a meaningful life. I seek the skills necessary to make this possible for as many people as I can help.

I am feeling very contemplative today. I look forward to returning to the hospital on Monday...

Monday, January 2, 2017

Inpatient Therapy Reflection: First 5 Months

I missed a week of therapy with my clients, and I really missed it! Two of my clients missed two sessions because they did not want to meet twice in a row, and all of my clients missed another session with my week out.

I was at the hospital Thursday, and was reminded how much I love it. On top of that, I had three out of three really great sessions with my clients. Last year, my first year of conducting individual therapy, was really challenging. I constantly worried about my clients' well-being and never felt like I was doing an "evidence-based practice". Therapy was stressful most of the time, and did not feel very rewarding. This year is feeling very different. I look forward to going to the hospital every day (which never happened last year), I am starting to feel like I am really integrating evidence-based practice correctly (which I rarely felt last year), and I am a lot less stressed than I was last year. I think part of this change might be the setting (I am really loving inpatient) and part of it might be that I'm feeling more comfortable conducting therapy. A big part of it is also the population. I really love working with people with serious mental illnesses and schizophrenia.

I met with a coworker to discuss some clients and coordinate treatment. One thing she said that stuck with me was "You have to find their strengths", referring to people with serious mental illness (specifically schizophrenia). She really emphasized each person's qualities that make them unique and clearly cared for each person she works with. It takes a certain clinician to speak in this way, and I really love working with these types of people. If we, as clinicians, are able to show people their strengths, and highlight those, every person can have a meaningful life.

I have been wanting to do this for so long -- sometimes it feels surreal. Working with this population is the most rewarding thing ever. People really appreciate the time you spend with them and are very open. This population has a horrible reputation, and I find that very sad because some of them are the best people I've ever met. When the day comes to leave this place, it will be a very sad day. I am thankful to spend time with these individuals.

Tuesday, December 13, 2016

Treat others as you would like to be treated

The other day, a patient at the inpatient hospital gave me a Christmas card. I was very touched when he made a point to make me a personalized card. This particular person is known to be hostile towards others and not very friendly. Ever since I've worked at the hospital, I've always made sure to speak in a kind tone towards him and say hello whenever I saw him. He always says hello back, even when he's listening to music with his headphones. Sometimes he asks my name when he forgets it, and sometimes he talks to me randomly. He has never been hostile, aggressive, or unfriendly towards me.

When he gave me the card, I told the unit Psychologist. She said something along the lines of, "That's so great for him! He likes people when they treat him like a human being." This broke my heart and reminded me how some of the staff members talk to the patients. Just the other day, a staff member said something to him in a very rude, loud tone, basically giving him some sort of direction related to a rule. He responded with a loud, "Fuck you, bitch!"

Patients can sometimes seem scary when they are symptomatic and/or delusional, but most of the time it is not directed towards people in the environment. I think another contributing factor is how symptomatic people can be, and how that tends to create a dividing line between psychiatrically healthy people and people diagnosed with a psychiatric illness. There are several people on the unit (both my own individual therapy clients and other residents) who have a reputation for hostility, but are kind to me. I have met so many amazing people who have a psychiatric illness. People who have a diagnosis are no less human than those of us who do not. Unfortunately, not everyone feels this way, and some very disrespectful people end up working in the mental health field. Treating people with respect and dignity is very important to me in my work (and of course, life in general). How you treat others can go a very far way, and I have witnessed this first hand.

Saturday, December 10, 2016

Ph.D. in Progress

Wow, it has been a long time since I have written. I have been so busy with my Ph.D. program at the University of Missouri in Kansas City (UMKC). I was reading some of my old posts and am truly amazed how much things have fallen into place. Let me give you an update...

I was admitted to UMKC to begin in Fall 2014 with a lab focused on serious mental illness. Since then, I have been involved with a project collaborating with a local community hospital and their treatment program Cognitive Enhancement Therapy (CET). CET helps people diagnosed with serious mental illness (primarily schizophrenia and autism) learn neurocognitive and social cognitive skills. Reading my last post reminded me how long I've been wanting to be involved with treatment research. I couldn't ask for a better project to be involved with. I absolutely love it. Our collaborators are awesome and really care about the people they work with. Our Co-Primary Investigator is one of the most skilled clinicians I have ever met (especially working with individuals with schizophrenia). I am so grateful for my mentor who pushed this project along and has been very supportive along the way. We have been very lucky to have this project funded since it has begun. I love observing and participating in groups, spending time with each participant (especially learning each person's unique perspectives), and sharing our project with the world. I look forward to continuing my involvement with the project.

I have also very much enjoyed formal practicum experiences. I began clinical practicum in my second year in the program (last year). I started at a local free clinic conducting individual therapy. This was my first time doing therapy. It was admittedly challenging and frustrating, but I truly enjoyed working with diverse people and having the opportunity to be invited into each person's world. This year, I have begun working at a local state psychiatric hospital. This practicum is on its way to becoming one of my most favorite experiences ever. I am facilitating individual therapy and group therapy. My unit is a long-term psychiatric unit with individuals with serious mental illness. My therapy clients primarily are diagnosed with schizophrenia. Before working here, I decided that individual therapy was "not for me". However, I am enjoying it so much now that I am reconsidering this. The people I work with are extremely open, gracious, and just enjoyable to be around. People on the unit amaze me with their resiliency and determination to reach their goals, despite being stuck somewhere largely against their will.

I have enjoyed my academic life at UMKC as well. The classes here have been challenging and very applicable to my future career. I am ending my semester and have one more class next semester. I have always been eager to learn, but am admittedly looking forward to being finished with coursework.

I have had a lot of different Teaching Assistantships since starting here at UMKC. Many of it has been positive, but other aspects have discouraged me from pursuing academia. I will keep the option open, but lately have been thinking about non-academic research and/or clinical careers. I have a bit of time to decide, but that's where I am now!

I can't neglect to mention the awesome friends I have met here. I wouldn't have been able to get through the tough times I've had here without my KC friends. I moved here to pursue my education and career, but was pleasantly surprised by the awesome people I have met along the way. My wonderful boyfriend moved here with me in 2015 after a hard year of a long-distance relationship. Life is always better with his support, and that is no different here in KC.

I will try to write more and continue to document my pursuit of a career focused on serious mental illnesses! Thanks for reading!

Thursday, May 16, 2013

First Year Complete

Wow, it's been even longer than I thought since I last wrote. My last entry was after the first semester and before the second even started. That seems to foreshadow how bustling this semester was!!!

I am currently enrolled full-time at the University of North Carolina, Wilmington in the Psychology Master's degree program. My concentration, General, is mostly meant to prepare students for research careers and/or to enroll in Ph.D. programs. I resisted this option (e.g. first earning a Master's degree then going to Ph.D., rather than straight to Ph.D.), but I can say now that I am really glad I ended up on this path. I was very stubborn about NOT doing a Master's first, but as it appears to be the best (and sometimes only) option for Ph.D. preparation, I am definitely starting to feel more ready.

This semester I joined another lab to gain more cognitive research experience. I am broadly interested in the rehabilitation and recovery of schizophrenia. I would love to become involved in a treatment-based research lab (such as development of a targeted social skills training program). I am also interested in involvement with a cognitive lab that either investigates cognitive deficits in schizophrenia, or develops cognitive remediation programs.

I am currently in what is called the Mental Illness & Recovery Lab. My project is working with the local Mental Health Court program. My thesis (pending prospectus approval) will be looking at the contributing factors of re-offending in these participants (namely criminal thinking and empathy). Mental health courts are diversion programs for individuals with mental illness involved in the justice system. Our research will help inform targeted treatments to reduce re-offense (for example, CBT programs targeted to reduce criminal thinking, which are available and have been tested mostly with incarcerated offenders).

The other lab I joined, the ACT (the Aging & Cognitive Training) Lab. This semester, I worked with the lab coordinators to develop a project that will evaluate the relationship between source memory and empathy. These two cognitive processes are impaired in schizophrenia. Although we will not be testing individuals with schizophrenia, establishing a relationship in psychiatrically healthy individuals may be useful to guide future research with individuals with schizophrenia. I worked on lots of literature review and started a write-up for this project. Hopefully data collection will follow in the fall semester.

Working in two labs definitely filled the extra time in my schedule I was concerned about having. I also was offered 5 extra TA hours working with the learning center to mentor students on academic probation. This was a very useful experience (minus the negative, which was a very high dropout rate) and I felt like I helped students either improve their academics or just figure out their life!

I really enjoyed the two classes I took this semester. First, Cognitive Psychology. I always LOVE cognitive classes. I find cognition to be so fascinating.  I learned a lot of interesting new things about cognition, but by-far, my favorite part of the class was writing the paper. We basically could write about whatever we wanted, as long as it related directly to cognitive psychology. I started off broad, but then decided to write about Mindfulness Yoga for Schizophrenia. Surprisingly, mindfulness and/or yoga has been used for schizophrenia, mostly to reduce stress & anxiety. I focused my writing on the potential cognitive benefits of mindfulness yoga for schizophrenia. Mindfulness and/or yoga uses many focused attention practices, thus may be a candidate training program for schizophrenia. And, importantly, it is a recovery-oriented treatment, meaning it increases self-awareness and improves quality of life.

Second, Research Methods. We basically learned to critique research articles throughout the class. I really needed this. I now read literature much more critically than I did before. I am glad I completed this class before submitting my undergraduate research anywhere for publication (fingers crossed). After this year, I realize that I probably was not really ready for doctoral-level training. I feel that after masters-level training is complete, it will be a much smoother transition to doctoral work.

So, this summer will consist of GRE prep (will take likely early August), publication prep (my unpublished undergraduate honors research), and thesis writing. I originally was considering getting a job to avoid dipping into the loans even more, but I think I will have plenty to do without one. I was feeling very stressed at the end of the semester, and I few months off will be nice. Oh, and fun things for me to do (!): lots of running/working out, 5Ks, beach days, exploring Wilmington/NC cities, and gourmet eating. Aaaahhh, so glad summer is here.....

Sunday, December 30, 2012

The awe of childhood

Today was my first day back in Wilmington. I spent the day doing necessary things such as unpacking, cooking, doing laundry, and grocery shopping. I decided to go to Walmart because there were several random things I needed in addition to the food items. I met someone wonderful while there.

As I waited in line at the register, a young boy (probably about 8 years old) and his mother were in line behind me. I overheard the boy ask, "Why does this say 'Why did he do it?'" referring to a magazine headline. The mother explained calmly that it was referring to the man last week who shot the children in the school. The boy asked a lot of follow-up questions in which the mother calmly explained the best she could what had happened. What I admired most was that she said "The man needed help that he did not get." She did not make judgements about the situation, she did not show anger towards what had happened, she just calmly told her son what she knew about the situation and that there was no rational explanation for what had happened. Another comment from the boy that I remember is that he said "I bet those were very nice kids." and the mother replied, "Yes, I'm sure they were." And the boy said, "I bet the parents are very sad."

The whole conversation made me realize that we all try to make sense of the tragedy that happened in Newtown Connecticut's Sandy Hook Elementary, but there is nothing logical about it. No matter how hard we try, there will never be a satisfying explanation.

After the conversation between the mother and child ended, the boy approached me and said, "Ma'am?" (Have I mentioned how much I love being called 'ma'am'? "What kind of kitty do you have?" He saw my cat scratcher on the conveyer I was purchasing. I proceeded to converse with him about my cat and his cat, etc...

I'm so glad I got myself out of the house today and was able to meet this wonderful young boy. He will grow up to be an intelligent man who I think will do great things. He is lucky to have such a great mom. Sometimes I forget how smart kids can be and how refreshing it can be to converse with someone who is so young.