Chapter 24: Graduation And Being A Therapist

Over the next four years of our life together, I was becoming successful in my field. I had gained a great deal of experience as a social work volunteer, followed by my jobs in the mental health field before I got my degree. These jobs were as a paraprofessional.

Lynn had been so supportive along the way and nothing would have been possible for me without her support. So, all the hundreds of people who were helped by me owe Lynn a debt of gratitude as well. I definitely needed support. 

I graduated from the University of South Carolina with a Master's in Social Work in May of 1996, but the education of a therapist/psychotherapist never ends.

By the time I graduated of my graduation with a Master's in Social Worker (MSW), I had a job to start in an inpatient psychiatric hospital named Brynn Marr Psychiatric Hospital in Jacksonville, North Carolina.

This seemed like a perfect opportunity because I had worked at "The Oaks" - a psychiatric hospital - as an intern which I mentioned previously in earlier chapters. The Oaks like Brynn Marr were somewhat similar.

I was hired with the title of "Therapist" on the adult unit. I was one of two therapists on the unit. Half the patients were assigned to me and the other half were assigned to the other therapist on the unit.

What I mean by saying that I was assigned half the patients, was that I was responsible for all aspects of their care while they were in the hospital, and I was responsible for discharge planning, also known as case management. That doesn't mean that I did the kinds of things that nurses and psychiatrists do. I just meant that I was the primary point of contact.

The other therapist on the unit, Leslie, had a master's in social work (MSW) like me and she was a Licensed Clinical Social Worker (LCSW).

I had taken the clinical exam right away after graduation and applied for the certification/credentials/license of Licensed Clinical Social Worker – Provisional (LCSW-P). I did this at about the same time I was starting work at Brynn Marr as I had to first graduate from college with my master's degree before I could take the clinical exam or seek that provisional licensure.

There was a substance abuse counselor as well, but he only offered group therapy sessions. It's interesting how lived experience as an addict allows people to work as a counselor without the same educational requirements, i.e., a master's degree.

Our supervisor was more of an administrator than a therapist or counselor.

There were several group therapy sessions every week that had to be run by either myself or the other therapist. We could provide individual therapy as well for each of the patients according to their needs, problems, interests, and diagnosis. I like the idea of a psychotherapist doing most of the therapy groups.

I found that the patients loved to have the opportunity to receive individual therapy sessions with me. This was incredibly good for my self-esteem and my sense of competency. You know that you are doing something right if you are finding that patients want to spend time with you for therapy sessions.

I did have a great deal of flexibility and freedom in offering or being available for therapy with patients.

In terms of group therapy, I had learned techniques in my second year of graduate school. I had observed the skills and talents of Chris Hauge at The Oaks who was a mentor of mine and who supervised me during my second-year internship.

I had picked up a workbook that had a number of ideas and techniques for running therapy groups – some ice breakers – to supplement what I had already learned.

The only problem that I noticed was that the hospital wasn't able to provide therapy services to those who didn't have good insurance. This was a for-profit hospital, and I didn't like the profit motive.

As a social worker, I had been motivated by a desire to help those who are most financially vulnerable within society. So, the idea of not being able to treat those who don't have good insurance didn't sit so well with me.

Later in my career, I would provide psychotherapy to individuals pro-bono. I NEVER wanted someone's ability to pay to be a barrier to my services.

You see this in so many settings. Sometimes it seems that the only people who "get it" when you are needy and need help are those who have struggled and dealt with poverty or homelessness themselves. We feel an obligation to share whatever fortune comes our way or whatever might be helpful.

That wasn't me though. Even before I knew real poverty, I could "get it" and empathize with the most vulnerable people in society.

Let me give an example of what I mean about my own values. There was a patient named Victoria - whose real identity I cannot reveal. She was there for anorexia and complications related to that. It became clear that she did not qualify for any more Medicare inpatient hospital days and I was asked by my supervisor to just focus on a referral for her to get treatment elsewhere.

This was my first job after graduation and so I didn't think of myself as necessarily an expert on eating disorders. However, if she wanted individual therapy with me, I wasn't going to deny her that.

My supervisor also wanted her to attend group sessions every day while she was there. I guess the staff started to think she was "difficult." Whatever challenges she might present, that wasn't a factor in how a patient should be treated.

She had said she felt that this was a hostile environment for her as a result of this. She had specifically asked that I be her therapist and not the woman therapist on the unit who was about my age but may have had a few more years experience than I did.

At one point, this topic of the hostile environment on the unit came up when I was sitting down with my supervisor. I was sitting alone with my supervisor when he asked me, "do you think this is a hostile environment for Victoria?"

I answered, "Yes, I think this is a hostile and non-therapeutic environment for her."

There was a point in the middle of the day when they were going to speak to her - the other therapist, perhaps the substance abuse counselor, the administrator (my supervisor). It seemed like they were ganging up on her. I made sure to be there to support her.

I remember her listening and she seemed uncomfortable, and I felt it too. I had positioned myself so that I was at her side beside her while the others spoke in a way that was confrontational, I felt. Symbolically, I felt it was normal and expected even in this setting for me to represent her interests. 

To make clear where I stood, I said "I have discussed how I agree that this has become a hostile and non-therapeutic environment for you, Victoria."

She was told that she needed to attend groups every day. 

She said emphatically, "fine, I'll go to Bruce's groups and that's it!"

Of course, that made me feel good. I'm not saying that Victoria wasn't a challenge. It just felt good to hear that I had made such a positive impression on a patient. This wasn't the only such experience.

In addition, it bothered me that my supervisor was seemingly implying that I could not provide therapy for Victoria because she needed to go to a place that specialized in eating disorders. And because they were not making money on her stay there! 

It was clear that it was about the hospital getting paid and that disgusted me!

She wanted therapy and would come by my office or I would walk around the unit and she would approach me asking to meet with me.

They seemed to want to just get rid of her since they weren't going to get a great deal of money from her. The master's level social worker that was also working on the unit seemed to have lost the passion that had inspired her to go into social work - that's how it seemed to me. That was confusing to me.

There were some patients like Victoria who had Borderline Personality Disorder, which can be challenging for therapists. I know my co-worker, Leslie, (the other therapist on the adult unit) used this term pejoratively and as their excuse for not being able to connect with and make progress with some patients.

There is a great book that gives the reader a great way to understand borderline personality disorder - it's called "I Hate You, Don't Leave Me." Some people will vacillate between idealizing and hating a person.

I believe this is a result of certain parenting styles.

At times I felt like I was walking on eggshells with Victoria. I felt challenged to demonstrate that I cared about her and was concerned for her welfare. Sometimes she would walk away angry and then come back or get up to go but then sit back down.

I remember her storming out of the office saying "you are just like everyone else, you don't care... I can't stand you."

Then the next day I saw her, and she approached me in the morning as if nothing happened. She just said, "can you meet with me for therapy?"

I answered, "yes, after group."

She smiled and said, "I'll be there for your group, I'm not going to Leslie's groups."

"I know," I answered with a smile of amusement, adding, "I'll see you in a few minutes."

You just have to be thick-skinned and not take things like this personally.

Thinking about being a couple

As a sign of my dedication to helping others and my enjoyment, I want to describe an experience when I was working as hurricane Fran was about to come ashore.

I had to learn to think about more than myself and my own lack of fear of hurricanes. Lynn would be worried about me working late as a hurricane comes ashore.

Lynn was much more afraid of hurricanes than I was. She was from California where they have earthquakes, and I would say that at least with a hurricane the earth doesn't open up like it's going to swallow you. We had debated which was worse a hurricane or an earthquake. To her, the waiting and suspense of knowing the hurricane is coming made it worse.

Anyway, Hurricane Fran was due to make landfall on the Cape Fear River in Wilmington after 8 PM.

I was sitting there talking to Victoria and the hour was a few minutes after 5:00 PM. I noticed a phone call coming in. Lynn had my direct extension.

"This is Lynn, I need to take this," I said to Victoria. I must have mentioned Lynn. 

"Hello, this is Bruce," I said not entirely sure yet who was calling.

"Hi," I heard Lynn say followed by "what are you doing?"

"I'm working," I said.

I could hear Victoria laugh as I said this.

"You need to come home." She said, "The roads are flooding and ..."

I listened to her concerns and said, "Okay, I will leave now."

"Be careful, honey, I am worried," She said adding "I have seen some of the roads. You might not be afraid of hurricanes as much as me, but you need to think about me."

"I'm sorry," I answered Lynn.

Victoria had been listening and she was understanding of the situation. I told her that I needed to go because Lynn was worried, and I said that I would see her the next workday. I wasn't sure if that would be tomorrow, Friday. As it turned out, I didn't come in on Friday after the hurricane, but I did come on Saturday. Victoria was there on Saturday.

Overall, I made good progress with Victoria, but I wasn't able to get her placed in a treatment center for eating disorders. Instead, she ended up moving in with another patient that she had met in the hospital.

Success and Accomplishments
 

It was amazing to me that I was able to overcome the social anxiety that I had throughout most of my life. The only manifestation of this anxiety existed when I had to lead therapy groups. I needed to be able to meet the challenges and do what the job required.

This was the career I had chosen, and I was determined to succeed. The sense of accomplishment that I felt in what I was doing - in being able to lead therapy groups - was rewarding and filled me with joy.

I had come a long way in my journey over these past 12 years!

I would feel a bit of anxiety when I had to run therapy groups, but I found a way to not let it show. I knew that I was talented and had a great deal to offer. This confidence in my competency made things easier for me. I also knew that if I wasn't doing a good job, the patients would have indicated this.

All eyes were on me during the groups, and I realized they were looking at me for guidance and treatment.

People came to my therapy groups and seemed to be getting something out of it and they seemed to want to listen to me.

Four years earlier, when I first arrived in Wilmington, I read my poetry to groups of people. I had stood up in a room and declared my love for Lynn in a poem. Now, I was doing something similar every day on the job.

There was something amazing about the realization of this. Like everything else happening in my life at this time, I didn't take anything for granted. I had a sense of awe whenever I reflected upon these things... and I did reflect upon everything that was happening.

I should say something about the setting... where I was working.

Brynn Marr Psychiatric Hospital was located near the Marine base at Camp Lejeune. Many of the patients were affiliated with the Marine base but not all, obviously.

One might imagine that post-traumatic stress disorder (PTSD) was a common problem that patients were confronting when they were in the hospital since there are veterans and veteran families. Combat experience can cause PTSD, obviously.

That being said, there were not that many veterans with PTSD that I treated. It could be that most veterans are men and it's harder for men to talk about traumatic experiences.

I saw a large number of women who were patients at the hospital and most of them had no military or combat experience.

I did work with one patient who reported that he thought he might have PTSD due to past combat experience and his fears and concerns were related to events that might have a basis in traumatic events and experiences during combat.

As I listened to him, it became more and more obvious that he was actually suffering from a psychotic disorder.

You have to keep your mind open and listen to others. You can't have pre-conceived notions such as assuming that a story that sounds like a traumatic combat memory is that. The location where Brynn Marr was located did not dictate how I thought about the experiences or patients. In other words, I didn't look for trauma disorders.

Anyway, as I was saying above, I knew that I was good at what I do. I knew I was competent and talented. That's an amazing feeling. I had a tremendous amount of passion for helping others and I had a tremendous amount of compassion and empathy.