New Bern

The job at Brynn Marr had ended, but my career had not.

I had connected well with patients. Victoria had asked to work with me. Karen had trusted me with experiences she had difficulty telling anyone else. Whatever problems existed between me and the institution, they were not evidence that I had chosen the wrong profession.

I began searching for another position and found one quickly at the Craven County Mental Health Center in New Bern.

The speed mattered. As with Brynn Marr, I was not wandering indefinitely after graduation, unable to find work in my field. Mental health agencies were willing to hire me. I had an MSW, direct clinical experience, provisional licensure, and a growing professional identity.

The problem was geography.

New Bern was approximately two hours from Wilmington. A daily commute would have consumed four hours, so I rented an apartment and planned to remain there from Monday through Friday, returning home to Lynn on weekends.

On paper, it was practical.

Emotionally, it felt wrong almost immediately.

Only months earlier, Hurricane Fran had made Lynn’s concern for me unmistakable. She had called because she needed me to come home safely. Soon afterward, I had accompanied her to Chapel Hill and remained near her during a hospitalization lasting approximately a week to ten days. I had lain beside her carefully, listening to her breathe and trying not to disturb the IV.

Now I was preparing to spend five nights of every week somewhere else.

Part of me wanted Lynn to say, “Don’t go.”

She did not.

That did not mean she wanted me away. Lynn respected my decisions. She was not going to control my professional life or insist that I reject an opportunity because of what she wanted. Still, I wished she had said aloud that the separation would hurt her.

Perhaps I needed to hear again what Fran had shown me: that my absence mattered.

The apartment in New Bern was barely furnished. The heater made noise through the night, but the rooms never felt warm.

The coldness was not only in the weather or the apartment. It was in waking without Lynn beside me and returning from work to a place containing none of our shared life. No cats. No familiar books. No poetry. No pottery. No conversation continuing from the night before.

I had worked for years to enter the mental health profession, but I had not done so in order to abandon my real life every Monday morning.

The job lasted approximately one month, from late December 1996 into January 1997. Memory gives it the dimensions of an entire winter. Perhaps that is because it revealed something permanent:

Professional work and life with Lynn had to exist within reach of one another.

When the New Bern position ended, I returned home and began looking again.

Once again, I found work quickly.

Duplin–Sampson County Mental Health Center

I accepted a position as a Social Worker III at the Duplin–Sampson County Mental Health Center in Clinton.

The drive was long—approximately an hour each way through rural communities, farmland, and pine—but I could come home every evening.

That difference changed everything.

I was no longer living in a temporary apartment that existed only because my work had taken me away from Lynn. Whatever frustrations occurred during the day, I knew where I was going afterward.

Home was not simply Wilmington. Home was Lynn.

At the clinic, I completed intake assessments, maintained a caseload, coordinated care, and responded to psychiatric emergencies. I worked with people experiencing depression, anxiety, trauma, substance-use disorders, schizophrenia, and other serious psychiatric conditions.

The clinic served many people who had few alternatives. Some depended upon case managers for transportation. Some lived in poverty. Others had been involved with the mental health system for years and had learned that appointments often consisted primarily of medication monitoring.

I wanted to offer more.

Therapy interrupted

The clinic employed therapists, but its structure did not always protect therapy.

I might be sitting with someone who had finally begun describing a frightening experience when the telephone would ring. If I did not answer immediately, the receptionist might call again.

When I finally picked up, she would sound irritated.

“The doctor is ready.”

“I’m with a client,” I would answer. “We’re in a therapy session.”

“She has to see the doctor now.”

The psychiatrist’s schedule governed the building. If the doctor was ready, the assumption was that everything else should stop.

Once, while I was meeting with a woman who had specifically requested therapy, the receptionist interrupted to announce that the psychiatrist was waiting.

“We’re not ready,” I said.

The client laughed softly. She understood my frustration, and for a moment we shared the small pleasure of resisting a system that treated her thoughts as less important than the doctor’s schedule.

The problem was larger than inconvenience. Therapy depends upon continuity. A person may spend most of a session deciding whether it is safe to speak. Interrupting at the moment she begins is not merely poor scheduling. It communicates that what she is saying can be displaced at any time by someone more important.

I did not believe that.

Listening beyond the diagnosis

One woman on my caseload had been diagnosed with schizophrenia. Ordinarily, much of her treatment would have centered on medication and case management.

She wanted individual therapy with me.

I added therapy to her treatment plan. Doing so also obligated the clinic to help her reach the appointments because she did not have reliable transportation.

I was interested in what her experiences meant to her. Hearing voices or living with delusional beliefs did not erase the rest of her humanity. She still had relationships, fears, losses, hopes, and a desire to be understood.

I had been influenced by writers such as R. D. Laing, who looked for meaning within psychosis rather than treating unusual experiences as meaningless neurological debris. I did not accept all his conclusions, but I shared the conviction that a diagnosis should not end curiosity.

Medication might reduce voices or agitation. It could not automatically resolve loneliness, trauma, shame, or the experience of living in a world other people insist is not real.

Some staff appeared to see little value in psychotherapy for schizophrenia.

The client saw value in it.

That mattered to me.

Clinical judgment

Part of my job involved traveling to the local hospital to evaluate people experiencing psychiatric crises.

If someone had attempted suicide or appeared to be in immediate danger, I assessed what had happened, whether suicidal intent remained, what methods were available, and whether the person could safely return home.

When hospitalization was necessary, I went to the magistrate to request an involuntary-commitment order and located an appropriate psychiatric placement.

These were serious decisions. An involuntary commitment temporarily removes a person’s freedom. Failing to act, however, could leave someone in mortal danger.

My recommendations were not casually dismissed or routinely overturned. I was trusted to make consequential clinical judgments.

That evidence matters because it complicates any later account that reduces me to workplace conflict. The system relied upon me to evaluate whether another human being required emergency psychiatric hospitalization.

People whom I had assessed sometimes returned to the clinic and asked to work with me. Even when I had participated in sending someone to a hospital against their will, the person could recognize that I had listened and acted out of concern rather than punishment.

The direct work was rarely the problem.

Respect and authority

Some attitudes within the clinic troubled me.

During one staffing meeting, a psychiatrist referred to the people we served as “chronic crazies.”

The phrase stunned and angered me. These were the people who made our employment necessary. They came to us because they were frightened, depressed, psychotic, traumatized, or struggling to remain alive. Their vulnerability did not make them ridiculous.

Another client complained that his medication caused distressing side effects. During the appointment, the psychiatrist appeared barely to listen while dictating notes into a recording device.

Afterward, I told the client that he had rights, including the right to raise concerns and participate in decisions about his care.

My approach created tension. Administrators wanted disagreements handled through the treatment team. I understood the procedural argument, but I also understood that a right that can only be exercised after receiving institutional permission is not much of a right.

This pattern would follow me through parts of my career. Clients generally experienced me as attentive and trustworthy. My conflicts emerged more often with systems that expected me to subordinate the therapeutic relationship to hierarchy, scheduling, billing, or administrative convenience.

That did not mean I handled every disagreement perfectly. I could be impatient. When I believed someone vulnerable was being dismissed, I sometimes confronted the problem before considering the most strategic way to respond.

My values were sound.

My method could still require refinement.

Supervision and becoming licensed

Throughout these early post-graduate positions, I received the face-toface clinical supervision required for independent licensure.

Some of those hours must have been completed at Brynn Marr, with the remainder continuing at Duplin–Sampson. The surviving narrative does not establish precisely how the hundred hours were divided, so I cannot reconstruct an exact ledger from memory.

What I do know is that supervision was not a formality.

I brought cases, questions, conflicts, and uncertainties to experienced clinicians. I continued learning how to assess risk, establish treatment plans, understand transference, manage boundaries, and distinguish a principled response from an impulsive one.

I was also undergoing psychoanalytic therapy with Marjorie Israel.

Her office was in her home, in a setting very different from the clinic. Our work moved slowly. She did not offer quick reassurance or simple explanations. We explored how childhood experiences might still shape my reactions to authority, criticism, and people who resembled my parents in their certainty or lack of empathy.

I needed to ask myself difficult questions.

Was I accurately recognizing indifference within an institution?

Was I also responding to older experiences of being ignored and controlled?

Both could be true.

Understanding the influence of my past did not require me to conclude that every authority figure was reasonable or that every institutional practice deserved compliance. It helped me think about how to defend my values effectively.

By late 1997, I had also completed training in clinical hypnosis. My education had not stopped with the MSW. I was adding specialized skills while completing the supervised experience necessary to become a Licensed Clinical Social Worker.

Leaving Duplin–Sampson

My time at Duplin–Sampson eventually ended.

I had fallen behind on some documentation, stepped outside expected channels, and continued challenging practices I believed interfered with treatment. I was asked to resign.

I did not enjoy losing another position. It indicated that I still had difficulty working within bureaucratic systems, especially when I believed those systems were failing the people they existed to serve.

But the departure did not resemble a rejection from the profession itself.

Clients had wanted to work with me. People experiencing psychosis requested therapy. Individuals I had evaluated during crises trusted me afterward. My clinical judgment had been accepted in decisions involving hospitalization and safety.

Most importantly, I had completed the supervised experience required for full clinical licensure.

I was no longer a provisional clinician waiting for institutions to determine whether I could practice independently.

I had become a Licensed Clinical Social Worker.

The question was no longer whether I could become a therapist.

The question was where I could practice therapy without having a receptionist interrupt a client’s most vulnerable sentence because the doctor was ready.

I began imagining an office of my own.