career development

I was able to complete all the requirements for licensure as a Licensed Clinical Social Worker (LCSW) within the state of North Carolina before I left my employment at Sampson County Mental Health Center.  

It was clear that whatever problems I had on the job had nothing to do with how I performed with clients or patients.  

As I explained, I had sought feedback, counseling, support, and guidance from my colleagues. I had joined the local chapter of the Society for Clinical Social Workers which had regular meetings where I could interact with colleagues in a congenial setting where we got to share our ideas, request feedback on casework, and learn from one another.  

It is through these meetings that I kept in touch with Chris Hauge who was a mentor of mine as I have mentioned. 

I had approached Chris seeking advice on entering private practice because I looked up to him... I had known that he had kept a private practice for some time. He had been very supportive of my goals as they related to making a positive difference in the lives of others.

The Keys to Success and Accomplishments

As it turned out, Chris said that he was considering retirement and that he was cutting back his office hours. He offered to let me rent his office space at a certain rate per hour if I used the office. This was a very affordable way for me to find success.  

I believe it was about $15 per hour - Chris wasn't using the office anyway during these hours. He told me the hours in which he used the office and when the office would be available. He shared an office with a partner - they had the main waiting room and reception area and two private office rooms where providers, like myself, could meet with clients.  

If I had to build a private practice on my own, it could be challenging to get started. I would need to build a base of clients that would be paying every week for treatment with me. If you rent an office full time you have access to the building any time, day or night, but you pay a monthly rate to do this.  

The cost to rent an office every month would be higher than the costs that Lynn and I were paying to rent our home - though her mother had been renting it to us and therefore we had gotten a great deal, a cheap rate for rent.

Chris gave me a key, introduced me to his partner and we discussed how I would record the hours in which I was going to use the office. He had a schedule I could consult to find out when the office was available.  

There are so many things to consider when you are pursuing a career in this field and when you are seeking to work in private practice. As noted, I had to consider Professional Liability Insurance or malpractice insurance, which are different names for the same thing. Chris needed to know that I had this coverage.

Billing is another issue. I had to file insurance claims for treatment with a client's insurance company or agency. So, I had to get registered with various insurance companies including Medicare. 

I had contracted with someone to do the medical billing as well and I got a post office box (PO Box) for non-personal mail. 

Having all my mail go to Chris' office didn't seem like something that I wanted to do yet. If I did not go to the office because I didn't have a client that day, then I might miss my mail that day. There was a place where I could get a PO Box close to our home.

It's great to have someone with whom you can consult when you are doing all these things and Chris was helpful in this regard as well.

Then I had to advertise in the newspaper and online. The internet was still a bit new in the late 90s, but I was able to create a website.

Other Advice That I Received from Colleagues

It's important to reflect upon the support I got from colleagues as well as the therapy or treatment that I had been receiving.

I became interested or curious to learn something about psychoanalysis and I began to study this formally from an organization that provides certification in psychodynamic/psychoanalytic therapy. The organization provided learning objectives, credits, coursework, as well as certifications for mental health and psychological professionals.  

I would go and see Marjorie Israel, who worked out of her home. She was a clinical social worker like myself and I met her at those meetings. 

Marjorie invited me to her home office. It was an interesting and scenic location. She had a nice yard with flowers and plants in a beautiful and serene garden with a curving sidewalk.

I would lay back on her couch and do free association or recount my dreams. It was reminiscent of Freudian psychoanalysis with the psychoanalyst and the couch. Marjorie said that she had to modify her approach since psychoanalysis traditionally had been done with a client coming four or five days a week for years.

She also engaged in more talking than traditional psychoanalysis.

While so much of psychoanalytic theory is hard to prove with research, I was interested in a technique where I would not be censoring anything at all. I was interested in making sure that I covered everything going through my mind – my motivations and hidden desires. I didn’t want any issues from my past to interfere in my role as a therapist for clients. 

Clinical Hypnosis Training

As I was studying Clinical Hypnosis, I saw some of the ways this can be used to help others deal with various problems and challenges. Some of those challenges and problems that people turn to a hypnotherapist to overcome are well known, like smoking cessation, weight loss, and phobias.  

Anxiety and phobias can be overcome through behavioral techniques like systematic desensitization. In this technique, a person breaks down their phobia into progressively more challenging and/or frightening scenarios or steps while pairing that with relaxation.

So, for example, if one has a fear of flying, they might break things down so as to cover planning for the flight… driving to the airport… waiting to board the plane… getting onto the plane. They would visualize this during hypnosis.

Hypnosis can be used to create a feeling of peace, relaxation, and serenity. Then when the person is in this relaxed state of mind, they can visualize the anxiety-provoking situation. This now pairs a relaxation response with the stimuli or phobic situation, experience, or trigger.

Starting My Practice

One of my counselors cautioned me that Wilmington was a saturated market, meaning there probably isn't a market for another psychotherapist in the Wilmington area.  

I was going to prove him wrong, which would make him happy actually. I mean, he had my best interests in mind. He was speaking only about the market for therapists. 

I did start to pick up clients rather fast. I had selected a few words to use in the advertisements that I hoped would be problems that people in the area had and/or things that interested me. So, initially, I thought of advertising that I could help individuals who are dealing with anxiety, depression, eating disorders, relationships. I added that I could use hypnosis to help with quitting smoking, weight loss, or other problems.  

This seemed to work out well for me. I used a second phone number that rang at my home, but the location of where I was living was not revealed. 

One guy started paying me out of pocket for weight loss. 

Then I picked up a client who had relationship issues. He said that he was gay and asked if I could help. I reported that I could help. To me, relationships require active listening. So, I would demonstrate that in the sessions with the client and help him to learn how to increase his communication skills in the same way.  

It's interesting that people in relationships that are non-traditional relationships will understandably want to know if we are comfortable listening to details about their intimate relationships.  

Returning to the topic of psychoanalysis, we get terms like transference and countertransference from this field.

Transference is about how the client reacts to or responds to the therapist. It can relate to projection where a client projects onto the therapist ideas and feelings that exist in another relationship.

Countertransference is how therapists respond to the client and the client's behaviors. I was working on my own "issues" to ensure that none of my past was carried into the therapy sessions with others and would cloud my judgment. This was part of why I went for analysis with Marjorie.  

Anyway, I also picked up a client who was dealing with major depression. Another issue that I was treating was anorexia. I had taken on a client who was in college and had come home with her family hoping to return to college later.  

Eating disorders are particularly challenging, and so I will devote further time to this topic later. 

My client base was growing, and it was getting to the point that I needed more access to the office than what was available while renting from Chris. I also found that by paying a flat rate every month, I could save money.  

Recognizing these accomplishments was amazing and a cause for celebration. So, Lynn and I went out to dinner at one of our favorite restaurants. Everything was amazing and a celebration was called for!

This has been an overview of the various types of clients I was seeing and the problems or issues I was treating. Later chapters will go into more detail so I will ask you to keep reading with me.

First, let's talk about family life so that you, dear reader, will know that I had another life outside the office. 

It seemed like anything was possible indeed if you put your mind to it and work hard. There is a career or profession for everyone; an area where one is most adept; a field where one is meant to work. I had found my career and my direction in life and everything was falling into place.  

In this section of my autobiography, I will describe the success I found as a mental health professional, a therapist (a psychotherapist as opposed to a physical therapist), in private practice. Just getting to this place in life and in my career demonstrated the many accomplishments I had made in my life.   

I had achieved the recognition of my colleagues and the admiration of my friends and family. I felt like my family was now very proud of me and amazed at all my accomplishments. 

It would be a logical assumption to think that your family is proud of your accomplishments and happy for you. It would be years before I realized that this was not the case – that they had not cared about my happiness or success at all!

These were things that I sought after my whole life. I mean who doesn't want their parents, their brother, and sister to be proud of them? Or similarly, we want our friends to be amazed and to admire us for our accomplishments. I had friends who were interested in what I was learning and my accomplishments.

Among my colleagues, this success and these accomplishments gained me recognition in the field which is very valuable.  

We want our colleagues to recognize our success because this helps us network, get new client referrals, as well as confirm our sense that we are doing things right. We can appear as an authority in our field as well. Most importantly, this confirms for us that we have what it takes and our skills, talents, character, expertise, as well as trustworthiness, are recognized.   

I will describe the types of treatment techniques or modalities that I employed. You will learn about the various therapies and diagnoses, problems, or issues that my clients had for which they were seeking my treatment.  

Therapists in the mental health or psychiatric field use techniques that they choose to specialize in employing. It's not the same as treating a medical problem where there is a very specific treatment that exists for a specific problem. Instead, the skills of a therapist are employed and adapted to the needs of a client.  

I had always wanted to help others regardless of their income, i.e., the most financially vulnerable and well as those who are vulnerable due to other factors such as having a mental illness.

I could see clients on a pro-bono basis (for free) if they could not afford to pay for treatment.  

My life with Lynn was something that sustained me, brought me so much joy, peace, support, self-esteem, and self-confidence. Sometimes it is said that we shouldn't rely on others to feel good about ourselves or to maintain self-confidence. That might be true but if there is someone who gives us these positive feelings then that is very helpful and valuable.

In this section, I will describe all these things.

While I was working at Duplin-Sampson County Mental Health Center in Clinton, North Carolina, I had a number of different responsibilities. I was hired as a Social Worker III. That was my title. I worked as a therapist/psychotherapist and I had to do intake assessments, as well as maintain a caseload of some fifty or so clients who came for therapy and medication monitoring.  

I was frustrated that they didn't let us do therapy with clients without being interrupted. Other mental health clinics in North Carolina manage this but they couldn't figure this out. I would be meeting with someone and the receptionist(s) would get mad if I did not pick up the phone if I was in session with a client.  

Sometimes I would pick up on the second call and they (one young woman was the most irritating) would ask me why I didn't answer, and I'd say "I was working with a client - we are doing therapy. I was distracted."

"Well, she has to see the doctor and he's ready."  

I would think, and sometimes say, "I'm not ready" or "we aren't ready." I would then say “she’s a real bitch!”

I didn't like the psychiatrists and some of the staff. It didn't seem that they respected the clients. I worked side by side with other therapists/social workers, mental health nurses, and case managers.  

At least at this job, I was more than a case manager as I had been in my previous job that lasted all of one month. You don't have to have a Master's in Social Work to be a case manager. Plus, I was at home with Lynn every day.

The case managers would bring clients to the clinic for the day treatment program or for sessions with me. So, that was cool.  

I was meeting with a Licensed Clinical Social Worker (LCSW) and finishing up my requirements for becoming an LCSW myself - I was still provisional.  

I remember being in a staffing meeting when a psychiatrist remarked that he works with "chronic crazies all day."  It infuriated me. Plus, why did he think that he was free to speak like this in the clinic? Was this okay here? Did people have such little respect for clients with mental illness?

It's a good thing I was going to get all the hours I needed for my LCSW before leaving. I had in mind working in private practice once I was licensed. Can you blame me?  

I reasoned that I could still work with vulnerable people who didn't have lots of money. I had been told that there are ways to be accommodating to people with a limited income when you work in private practice. For one, you can work pro-bono – for free – if people can’t afford to pay or if they cannot afford the flat rate.

Anyway, one of my duties was to visit the local hospital to do evaluations at the local hospital to determine if someone required psychiatric hospitalization, such as was the case when suicide was involved.  

I would make an assessment as to what happened... how did they end up at the hospital? What method was used to end their lives if that was the case? Did they still have access to that weapon or method of suicide?

Most of the time they were indeed suicidal, and I had to go to the magistrate to request involuntary commitment orders. They would then be taken to the clinic (sometimes) to get the doctor (psychiatrist) to sign the order for commitment.  

I was never over-ruled in my assessment. I mention that because not everything I observed and concluded about the treatment of a client was something that the psychiatrists and I saw eye to eye on.  

Interestingly, some of these people who were committed to an inpatient hospital (I had to find a placement also) were my clients or I would offer to work with them. Here, I was sending them to a psychiatric hospital against their will for a commitment and they are happy to work with me when they get back!

I say all this to illustrate why I wanted to go into private practice. Not only would I have more control of how things are run but I knew that when it came to working directly with clients, I NEVER had any problems.

I did work with clients with psychotic disorders like schizophrenia and many people at the clinic seemed to see very little value in psychotherapy treatment for schizophrenia. So much revolved around the psychiatrists and they seemed to control the decisions about the treatment of mental illness or psychiatric disorders in the area for those who could not afford to go elsewhere.  

Culturally, the area is rather rural. Pig farms were very common around the area and this created a stench, to be honest. There were a lot of trailer parks. Pockets of Spanish-speaking communities dotted the countryside, and my knowledge of Spanish was useful.  

The population was over 50% white and just over 25% African American, but that being said, the ratio of clients at the clinic was about 50-50 White and Black. That reflects the role income plays in access to mental health services or being exposed to the mental health system.  

The attitudes of the staff to the extent that they were somewhat disrespectful of clients and the therapy process had more to do with the attitudes toward mental illness than racism.  

Towns were small. People knew one another.  

For example, there had been a violent murder in one of the nearby towns which made all the newspapers. The murder and trial had been a few years ago, but the sister of the murderer was still hiding her face in public. She was my client and she had come into the clinic wearing a scarf.

The things I was learning also seemed to be met with superstition among the religious folks of the area. I was studying clinical hypnosis and I remember one client saying she was afraid that the trance state might make her vulnerable to the Devil or Satan. That was the first time I had heard something like that.  

Some of the delusions that people had were obviously religious. That should come as no surprise in a rural county.  

I was curious and confused a bit at times by the nature of different hallucinations that I heard described. I met with people who described hearing voices, seeing things, and tactile hallucinations. When I say I was confused, I mean I had an open mind, but I could not readily understand what a particular experience was like. So, I listened to the descriptions of various experiences being described by clients.  

I wasn't judgmental or anything, but I sometimes didn't want to just take the word of the psychiatrist regarding a diagnosis and the proposed remedy.  

Take for example a client who had primarily tactile hallucinations of crawling sensations on her skin and possible delusions about an unknown disease. The doctor saw her for fifteen minutes and maintained her on Zyprexa. The side effects of this anti-psychotic were not as serious as those of older anti-psychotic medications like Haldol, but it was still a major tranquilizer.

There has been certain wisdom that only psychiatrists can diagnose mental illness or psychiatric disorders. I question that. I mean, the doctors were not doing medical tests when I brought the clients in front of them, and they processed clients every fifteen minutes.

Client Rights and Treatment Results That Match a Client's Needs and Concerns

I just felt it was valid to really listen to people to understand their experiences. Was the medication making their life better? That's what I wondered.  

My attitude toward at least one doctor was somewhat cautious if not suspicious - the doctor who referred to clients as "chronic crazies" and one of his colleagues.  

One day, I took a particular client of mine to see the psychiatrist. My client was complaining about the side effects of the medication. The doctor acted like he was ignoring him! And he held up the microphone to the dictation machine and dictated notes while speaking to the client. It was offensive to me!    

He was referred to a day treatment program, I went and looked for him. Technically I wasn't supposed to meet with him for treatment at this time, but he was on my caseload. He was still my client. I told him that he has a right to refuse to take medications and to put that in writing.  

That got me in some trouble. I was told that I should address it with the team!

Another client had schizophrenia and the general sense I got was that psychotherapy for this condition isn’t a high priority. This young woman wanted therapy with me. So, I just added it to the treatment plan. If that is what the client wanted, why not.

Luckily, they didn't go out of their way to over-rule the preferences I made for how I would provide treatment if there was time. 

By adding therapy to her treatment plan, that also obligated the case management team to bring her into the clinic because my client didn’t have her own transportation. The case managers were good about that and didn’t complain. 

These are just prototypical examples of my experiences.

Nancy's Curious Trauma Symptoms

I started seeing one client who had some unusual symptoms. Her name was Nancy. She had come in dealing with depression and panic attacks. Those were her diagnoses.  

Nancy was 27 when I started meeting with her.  

She began to describe some dissociative symptoms that one might find if a person has experienced something traumatic.

I would listen to her and ask her to clarify what she meant.

I had a few structured interview techniques that I was using to explore these experiences.

I would ask very open-ended questions like "Can you tell me what that is like?" I wanted to be sure that nothing I might feel about her experiences influenced her responses or my exploration.

Also, the interview questions that I was using as a guideline were very subjective. Asking "what's that like?" can help to increase our understanding of what life is like for a person. I use the word "our" understanding to indicate that both I and the client are working together to understand what is happening.  

I asked about traumatic experiences as well, such as sexual assault. She mentioned an event in which she had been sexually assaulted a couple of years ago.

I did try to broach the topic that something more might be going on than Major Depression and Panic Disorder. The doctor hardly seemed to be listening. Nancy was right there, and I was alternating my gaze between her and the doctor. 

He just asked more questions about her medications.

After meeting with the doctor, she said to me, “I was telling you that the medications are not helping with my problems.”

“I know and I wish I could do something about that,” I told Nancy. “I can’t advise you about medications.”

“He wasn’t even paying attention,” she said.

“I know but I am, right?” I asked.

“Yes, I appreciate that you believe me,” she said.

“Do you mean some people don’t believe you?” I asked.

“Well, my boyfriend doesn’t understand things and before you, I stopped coming to the clinic,” she said.

“What’s not to believe?” I asked.

“I don’t know,” she answered.

I had used a popular interview schedule that had some questions that were medical and thus outside my area of expertise but the information I gathered would be helpful.

We ruled out substance abuse or use.

It was somewhat amazing how competent and disciplined Nancy seemed. Her job and career did not indicate college plans, not yet. That's unfortunate that she had not considered this because she seemed bright and intelligent.  

We discussed her experiences of child abuse and trauma. This is where it got very disturbing. It’s also amazing what she remembered. I tried to keep this clinical and to avoid pulling her into any of the memories at this time. So, we moved along in a matter-of-fact manner.

The abuse in her childhood was both physical and sexual. It was rather disturbing what had been done to her by men and women. She confirmed that she had been forced to have sex with people of different sexes, ages, and even with animals as a way to make her feel shame or as a form of punishment.  

Obviously, this was all very disturbing.   

She admitted and described things in such a matter-of fact-way that made her seem so believable. It wasn’t like she stopped and said “no way, that’s really disturbing.” 

She would pause when I asked a question, then say "yes" or "no" to various questions. I tried not to use any suggestive phrasing or to indicate approval or disapproval for any of her answers.  

Sometimes people can over-represent their problems or symptoms as a cry for help or indicate a need for help - perhaps even to indicate that one deserves the more intensive treatment that is available.  

She would provide details after she answered "yes" to a question as she recalled examples of an event or an experience. She actually didn't seem overly eager to participate all the time in therapy. So, it didn't seem like she was going out of her way to gain my sympathy. 

This interview was done outside the clinic. We went outside because it seemed more accommodating to her. Her mood and interest changed at times. 

She was vaguely aware of hearing voices and a feeling that she was different at different times. Her experience of amnesia suggested a dissociative disorder.

There was so much more to explore. I did present my findings with the doctor at our next session and suggested that there might be more to explore.

At some point, when speaking to me alone, the doctor indicated that he thought I was suggesting that she had Dissociative Identity Disorder and that he didn’t believe in that disorder. That is a condition in which people have different personalities. 

I indicated that it is too early to tell but it was frustrating and confusing that any diagnostic disorder was “not believable.”

Unfortunately, my experiences at Sampson County Mental Health were ending. I was asked to resign. The chance to work more with Nancy was interrupted shortly after I had made such progress and had helped her to gain some insights and to feel like someone was listening to her.  

There were a number of reasons for my departure including going outside the traditional structure of the clinical staff, being behind on paperwork/charting, and a few minor issues that reflected my unique values that may have been out of step with this clinic.

I had gained the clinical supervision hours to qualify for the certification as a Licensed Clinical Social Worker and that meant I could go into private practice.

During the next section of this book, I will discuss my experiences in private practice. This was the height of my success and where I had been going with my career for as long. I had accomplished so much over the past fourteen years. So many accomplishments.  

Keep reading... with the next chapter. It will be exciting. I would love to share the story and the joy of these accomplishments.  

I have always believed that therapists should be willing to get therapy themselves. First of all, it can be educational to understand ourselves so that we can understand others. As such, our own therapy is a part of our education.  

We have all lived and been impacted by life. Some of the best therapists that I have known have been in treatment for various psychological issues and problems. Some of them also have dealt with additions... trauma, victimization, anxiety, and other problems.  

Perhaps it makes us more understanding of the struggles that others might face in life. We also have seen the healing power of psychology and psychotherapy treatment techniques. 

As an undergraduate student, I developed communication and social skills through the use of counseling and psychology. It included but was not limited to cognitive behavioral therapy techniques. It was something I had to do.  

I was obviously very successful in my efforts or I wouldn't be doing what I have been doing all these years.  

Certain skills that we learn as mental health professionals are learned through practice and experience. For example, consider hypnosis which I studied. Let me tell you about that.  

I had enquired of some of my colleagues what organization provides the best most recognized training and certification. The answer I got from some hypnotherapists that I knew was the American Society of Clinical Hypnosis (ASCH).  

I had been meeting with a therapist who provides clinical hypnosis to help me overcome some fears, anxiety, stress, phobias, and other issues - nothing debilitating but I was intrigued ever since I had some exposure to these ideas during my internship with Chris Hauge at "The Oaks." The use of hypnosis seemed to be somewhat similar to experiential techniques like gestalt therapy, inner child work, visualization and etc.  

So, after I got my degree and while I was working in the field, I traveled to Chapel Hill from Wilmington to participate in an ASCH-certified training program taught by a professional who was certified to provide training.  

It was fascinating and very useful. Somehow, I was able to get one day off from work and it was justified as required continuing education credits that all clinical social workers are required to obtain every year.  

I know that I was getting more than the minimum required training for licensed clinical social workers.  

Self-Discovery and My Own Personal Therapy/Treatment 

I had changed jobs a few times during that time period after graduation for reasons that had to do with my values and interests as compared to the settings where I worked. I did mention that there were some issues that I had with Brynn Marr. 

I had three jobs before I started my own private practice. I know that might seem bad because I had been changing jobs three times in about two years during the years 1996, 1997, and 1998. With Brynn Marr, I found that the ethics around how they operated were not consistent with my ethical values.  

Lynn had heard things about them and so she wasn't surprised that this didn't work out. Then I started a job in New Bern for one month in late December and into January of 1997 and I was miserable. I couldn't make sense of why Lynn was fine with me taking this job away from her from Monday through Friday.

I had gotten my own apartment up there, which was cold, empty, and desolate. Maybe I should have waited for a better job which would have been a better match and closer to home. This was a Case Manager position, and I was just doing screenings to determine if someone needed hospitalization for psychiatric reasons.

The biggest problem for me was being away from Lynn all week. Hadn't we committed ourselves to one another to live as husband and wife? She didn't seem to protest my choice to be away from her all week! That only made me more depressed. 

It just didn't seem right to me. I don't know if she thought it was a good opportunity for me and just didn't want to stand in the way of opportunities, but I wanted her to say she was sad that I was away. I know that if it had worked out, we would have to find a better place than the apartment I was renting.

I finally told her how miserable I was up there. I still had to pay rent to her mother for our home in Wilmington.  

Anyway, we were in love and I had to be with her. I could not visualize where this was going to go for me. We were much happier together. There was nothing that had happened to divide us during this time, but she understood that when it came to family and love, of course, I was driven by my passions. 

The job lasted only one month before I was fired! I had been allowed to resign from Brynn Marr but not from this job. I don’t even remember why I was fired but it was good that it happened that way.

Other parts of my life were dictated by rational thinking and careful decision making but love and family are what really mattered the most to me – to us!

So, I did get a job after that at Sampson County Mental Health Center.  

I was also in therapy to find out why I was having some problems matching my dreams, career aspirations, plans, and goals with practical examples of success. The decision itself to go into Social Work was a decision based on my values. I was idealistic all along in terms of what motivated my choices to pursue this career.     

As I mentioned earlier, there was one time when she went into the hospital when her lung functioning had fallen a bit low. Again, I, or we, had to live in each moment together without panicking about her health. Indeed, that had an impact on my mental health.  

No one that I was seeing at any time said to me that I have problems that limit my abilities as a mental health professional. Every problem, i.e., job change, was a learning experience.  

Of course, it's depressing and stressful when the woman you love has to be hospitalized because her lung functioning is problematic.  

Anyway, I was going for psychoanalysis, with Marjorie Israel, Clinical Hypnosis with another therapist, and I was seeing a therapist at the Family Counseling Center in Wilmington. I wasn't doing all this at the same time but there was some overlap.   

I took my responsibilities seriously and had a drive to be successful - more of a driving passion.  

There was another problem that had to be addressed. The impact of abuse or being assaulted by my parents previously was still a factor in my life - not so much on the job but at home. I had nightmares and I was struggling to understand my own sense of self-identity.  

I knew who I was, but some religious ideas had bothered me because they existed as absolutes - rules - that created fears and problems in our lives. Lynn was more open-minded and carefree. Anyway, I had ideas about right and wrong, and Lynn believed in things that didn't match those ideas.  

She was such a good person and very full of Christian love without being a Christian. There were certain beliefs that I had, and they were like absolute truths and Lynn would challenge me. So, I was still growing and developing in some ways.  

But we seemed to be arguing a great deal. So, we went for couples counseling at the Family Services Center in Wilmington. We saw an older guy who went on to be a Clinical Social Worker after working in a different field for a number of years. I think he was in his 60s.  

We made great progress when I had something of an epiphany. Lynn wasn't worried about the nightmares, but when I got mad, I sometimes threw things. She once said "what if I was there where you threw that... " whatever it was that I threw the last time.  

I thought "you weren't there, or I wouldn't have thrown it" but I didn't say that. I was deeply ashamed and shocked. "What was I thinking?"  I thought. To do anything to make Lynn scared was so unacceptable and wrong. I was scared because I knew that I was lucky to have Lynn in my life. And she doesn't put up with anything like some men and women in relationships put up with disrespect or anything.

Our arguments never got to the point of either one of us disrespecting the other person.

What I mean is that if she thought I knew she was scared and did it anyway, she would have left me. She was NEVER afraid to make sure to speak her mind. I mean if we were having an argument and if I tried to walk away in anger, she would follow me.  

She would say, "I'm not done talking to you." 

I had a punching bag, and I would hit that if I got angry and frustrated. But every time she followed me outside, I stopped to be sure not to hurt her or anything. I could not imagine letting anything scratch or bruise her precious body and she knew that for certain.  

She had seen the way I acted when she was in the hospital and had to get IV antibiotics and how much I told her I wanted to stop them from piercing her skin... but it had to be done.  

Anyway, it only took the shock of hearing those words “what if I was there when you threw that” …  those words sent chills up my spine. That kind of expression of anger could NEVER happen EVER. So, I had a powerful motivation to overcome my impulsive anger.  

I know it was related to the abuse I had experienced from my parents. So much pent-up anger! 

It was weird because Gestalt therapy encourages screaming and hitting a chair or something to release the anger that has been stuffed down inside as a result of abuse or trauma. I just had to do that in controlled ways.  

I was instantly cured of the ways I had been expressing anger when Lynn indicated that she is worried that someday I might accidentally hurt her. It took a while for me to compose myself after the shame I felt when she revealed this. Then I said, "it will NEVER happen again."    

She had responded, "I know."  

Obviously, she recognized the shame and conviction I had to ensure that I NEVER act in a way that is unacceptable to her. And I NEVER did repeat those behaviors. Not EVER! 

It truly sucks that a person can be so in love and have such a profoundly special relationship and still feel depressed at times. I suppose things were not perfect for us - I'm not talking about personal issues between us but just our situation, her health condition.      

With her limited income, she could have been the one person who might have expressed a desire for me to take jobs that paid more or for me to find employment with a large company that might provide insurance that would cover her.

Believe me, Lynn was not the type to hold back her thoughts, feelings, and desires. 

Post Graduate Continuing Education              

As stated above I was in training to gain the certification as a Clinical Hypnotherapist from the American Society of Clinical Hypnosis (ASCH). 

That wasn't the only area of expertise that I was pursuing.  

As I said earlier, I was glad to have the opportunity to get any kind of training that was available. I just loved learning new ideas, techniques, and tools.  

It was the mid to late 90s and there wasn't a treatment technique that didn't interest me.  

I was a part of the local chapter of the Society of Clinical Social Workers in Wilmington, which was for New Hanover County, NC. This was helpful in both finding out about training opportunities and in networking and collaborating with colleagues.  

Through this involvement, I could attend regular meetings, at least once a month, and discuss challenges that exist in our professional lives providing therapy to a range of clients with various diagnoses, conditions, or disorders.  

I will discuss this in greater detail in the next section of my book. First, I have a few more things to share about how I finally qualified for licensure as a Licensed Clinical Social Worker. 

One of the great experiences I had as a therapist, including during my role at Brynn Marr Psychiatric Hospital, was supervising an intern. I mean imagine the situation and everything that has come before in my life. I started college as someone lacking social skills and lacking communication skills. Yet here I was working in the field successfully where those specific skills are required, and I am supervising someone else who is looking to me for guidance.  

This is a testament to the passion and dedication that I had. I felt a sense of amazement at these many accomplishments and my success. Not only did patients look to me for guidance, insight, treatment, and direction but I had a student in the same field as me looking to me for education, guidance, and insights in a manner not so different than the way I looked to Chris Hauge, my mentor.  

Granted Chris had many more years of experience than I did, but this was still amazing. Mary was her name. She could have asked to work under the supervision of my colleague, Leslie, the other therapist on the unit but she observed us both and asked to work with me. 

There wasn’t anything wrong with Leslie. The situation described in the last chapter about how a hostile environment existed for Victoria was not something Leslie had done herself. 

Mary sat in on group sessions, met with new patients to gather information for the intake assessments, and sat in on individual therapy sessions with patients sometimes. This was helpful because I was finding that occasionally some patients would ask me to be their therapist instead of Leslie - I can't say that happened many times, but occasionally someone asked to switch.

I do not know why anyone was asking for me as their therapist. 

For what it's worth, and to me, it was worth a lot, no one had asked to switch therapists to work with Leslie instead of working with me. I may have had greater eagerness because I was new, but I've never lost that passion for trying to be the best I can be... to earn the respect and admiration of those I was serving.  

As I was saying in the last chapter, I did think that empathy is a quality that must be demonstrated. You can't just tell yourself that you are doing a good job and that you care about the welfare of others. You have to observe how people respond to you.  

So, did the patients continue to meet with me after an initial session? Yes. I mean, if you didn't accomplish anything with the patient, why would they return and/or ask to see you whenever they can? I could tell as I walked around the unit that people looked up and to me for my attention.  

Consider this, some people might be there involuntarily and waiting to get out as soon as possible. So, they would be going to group sessions to demonstrate that they are participating and to earn points with the staff who would decide they are ready to be discharged as soon as possible.  

In addition, while there are differences in the roles and there are boundary issues that differentiate patients and staff, there are still ways in which those boundaries and differences do not have to be so great that a patient doesn't feel comfortable wanting to interact with you and seek your help.  

Empathy as a Treatment Technique

Carl Rogers was a psychologist who pioneered the humanistic approach to psychology or psychotherapy which was also called client-centered therapy. He is known for his ideas about unconditional positive regard that a therapist should convey to a client or patient. This to me seemed like a basis for all other techniques.  

In a way, empathy develops by conveying the idea that the person is accepted and acceptable as they are and not based on some conditions about what they must be.  

As in previous chapters, the quality of the information gathered from a client or in this case a patient is directly related to the nature of the relationship and the sense of empathy that exists. As a therapist, we see things from the point of view of the other and experience with the other person. This increases the insights that can be gained for each person. For myself, as a therapist, I was looking for insights that would be useful in understanding the patients and helping them.  

Here is another example of how natural things seemed for me and how empathy, therapeutic technique, and skills were useful in helping a patient named Karen.  

I had noticed Karen in my group session one day and she seemed barely alive. Karen was a medium complexion African American young woman in her mid-20s. She was somewhat thin and was about five foot five or six.  

Mary brought her in to see me in the afternoon and said that she had interviewed Karen to gather information for the routine intake assessment that we were required to complete for the chart and to create a treatment plan.  

We sat down in my office and Mary tried to help Karen talk about some of the things that had happened to her. I was concerned and said, "You have been hurt."

In a very soft voice, she answered "yes."... adding "it wasn't the first time. My father and my brother did things to me when I was younger."

"I'm so sorry," I answered. "It's so sad that something like that should happen to someone so special."  

Some professionals worry about being authentic or genuine and complimenting others, but I had learned from Chris that there was a more natural way to be. Chris had been in the field for decades and was well respected so when he had introduced the idea of offering positive feedback to others because you can think of something to say even after only a brief encounter with a person that resonated with me.  

Karen looked so fragile, thin, sweet, and gentle. I was aware of counter-transference issues, so I kept some of those thoughts to myself but overall, it seemed hard to imagine not seeing her as a special person, so it just seemed so natural to say.  

It seemed like a look of sorrow came over her face which actually looked like it was a relief for her to be able to talk about what happened.  

She added, "I was raped" in a very feeble voice that was just barely audible and seemed to convey with it both a sense of relief in saying the words and a sense of shame as she looked away.  

"I am so sorry that happened to you. That is such a horrifying thing to happen to a woman," I said.  

I then added, "there are ways to process or work through the memory of the experience so that you can find some relief. I can help you to do this in a way that is safe while you are here... with me... with us."  

I wanted to do something. This was the setting for that. I had a sense that this didn't just happen last week. If she was shut down like this now, that meant that it must have been a weight that she had been unable to share with anyone... she must have felt a need to keep it to herself. Mary had been providing some insights from her earlier conversation.       

Karen seemed a bit curious and maybe confused about what we were going to do. I said, "there are experiential therapy techniques that are helpful in creating an experience of mastery over a traumatic event. Our imagination holds memories like this as snapshots that we are afraid to see. You won't be alone."

"You are safe now, right?"  

"Yes," she answered looking at me. I had studied some information about hypnosis and I was using only enough of those insights to try to resonate with her and to meet her experience - her breathing rate and such.  

While I was learning about experiential techniques with Chris, I had studied Fritz Perls and Milton Erickson as well as Bandler and Grinder, who developed Neuro-Linguistic Programming, where they drew upon the skills and techniques of geniuses in the field like Fritz Perls and Milton Erickson to model what the essence of what they were doing was.  

It seemed to me that this technique of matching the breathing rate, pulse, and vocal patterns was helpful in developing and demonstrating empathy because we had to tune into what the other person is experiencing.  

"I can stay with you too," said Mary.

"No, I don't want you to see," answered Karen.  

I had registered this as a need that I could understand because of the sense of shame that we sometimes feel at inappropriate times. I also recognized the need to be aware of transference and countertransference issues. Even if one doesn't specialize in Freudian or post-Freudian psychoanalysis, it is valuable to be aware of how a client or patient is reacting to us, how they are projecting their feelings unto us, and how we are reacting to them.  

Mary left and I said, "I am going to sit next to you and we can imagine a screen in front of you. This will allow you to review what happened like it was a movie instead of being overwhelmed by the pain and other negative emotions."

She asked, "you will be with me?"

"My voice will go with you."

"You don't have to say out loud everything that is happening... and you can stop any moment you want."

"I want to say what happened - it was bad," she said.

"Yes, it was bad what happened to you... but it's not happening now."

I knew that later we would also need to address the fact that what happened to her had nothing to do with her but I didn't want to give her too much information to think about until it was necessary to add more insights to help her. 

I suggested she take few deep breaths, close her eyes and picture a screen in front of her. I had been thinking about the gestalt therapy techniques that Chris used in the therapy groups. I had also been to individual therapy to work on some of my own past traumatic experiences to get a feel for how to do certain gestalt techniques. Chris and I briefly discussed the Neuro-Linguistic Programming Technique that I had read about as well...  

I also had taken a post-graduate continuing education course on related treatment techniques and ideas that relate to these experiential therapy approaches.  

Anyway, Karen was well-grounded with appropriate reality testing to benefit from this technique. Some visualization techniques can be problematic for someone who is having a psychotic break.    

I continued, "let's go back to when it happened. Imagine the scene in front of you if you can."    

I added, "You can squeeze my hand to know you are not alone and to help with your feelings when it gets scary or when you get mad..." placing my hand near hers on the arm of the chair.  

She grabbed and squeezed, and I said, "It's okay, that doesn't hurt me and you are okay."

"Let your body do what it wants to do, like kicking your feet in front or whatever."  

I knew from the techniques of Fritz Perls that to find the closure needed for relief we have to stop stifling our reactions and working to keep everything inside.  

She began to relax a bit as if the scene had faded from her.  

She opened her eyes and her face brightened and her posture looked different. She had a slight smile on her face.  

"Thank you," she said.

"No, thank you," I answered. "I mean for trusting me and for having a chance to see this look of relief on your face."  

"I feel... different," she said.  

I didn't say that I thought that more work would need to be done. Other things had happened to her and the impact of the rape was going to take more therapy to overcome.  

It seemed that what matters is that some sense of mastery can be found, and this can change a person's mindset and create a sense of possibilities... possibilities for healing from trauma.  

As always, I reflected upon the actions taken in the therapy session. It's always important to be aware of what is happening especially when you are close to another person - within the distance of human contact.  

I've had contact with a therapist myself though in a different way than squeezing someone's hand. Boundary issues are important. At the end of my counseling time in college, after five years working with the same psychologist, we hugged as guys do.  

During hypnosis with Chris and another hypnotherapist, I have had them tap my hand or knee first announcing that they are going to do that. There is even a technique where a hypnotherapist tries to verify with the client the phenomena of hypnotic trance by gently raising the hand and letting it hang in mid-air without awareness until attention returns to the arm and hand to allow it to slowly drop down to the person's lap. 

The point is that we do need to be aware of boundary issues, but it is possible to remain aware of what is happening. I had a wife at home, and I knew that nothing I had done was shameful in any way that I would hide it from Lynn.  

We were working on keeping her grounded in the here and now and in a safe place, so nothing romantic was creeping into the sessions.    

These were things that I considered, and much insight could be gained by going through psychoanalysis. I knew someone who was a psychoanalyst as a matter of fact. Her name was Marjorie Israel.  

Regardless of what different people think about psychoanalysis, there is a great deal of insight that can be gained by spending time free-associating and reflecting upon our reactions in different situations.  

The thoughts that I had when I approached her for analysis were that I wanted to find out about myself and what hidden or unrecognized motives and desires might exist within me that could have an impact on my work in the field with clients. I believe that there is common sense to the notion of transference and countertransference.  

I'll have to explain more of this in the next chapter.     

My tasks allowed me the opportunity to get to know others in a therapeutic setting. Recall that when a person is admitted to the hospital there is a short period of time during which the intake assessment for each department must be completed.  

Unlike during my first year when it seemed like they were making work for me to learn as a requirement for an internship, this was a setting where I was being asked to do something that was required by and for the hospital.  

This wasn't busywork. If I was asked to complete this, I was being counted on to do this. It was necessary and required. This made me feel so much more useful than during my first year where it was hard to see that I was making a difference. Also, as I said, Chris knew what I was learning from him and through my studies.

Instead of feeling bad about volunteering my knowledge, wisdom, and insights, I saw that what I was offering was valuable information to consider when evaluating what a patient was experiencing and perhaps how they could be helped. 

I had mentioned that during my first internship I had some doubts about my competency. I chalked up every "mistake" as a learning experience. 

Okay, so during the intake assessments we try to get a lot of information from a patient. Why they are in the hospital as they understand it... what has been going on in their lives... are they married? Do they have children? Can they describe their symptoms and problems? And so on.  

The ability to gather information from a person requires building rapport, creating trust, demonstrating empathy and compassion. The quality and nature of what you learn, what information you are able to gather, are a reflection of your skills and talents in this area. It’s also important to ask very open-ended questions as much as possible because the patient knows things that we don’t.

As you can see, I have come a long way from the young man who needed counseling to learn social skills, communication skills, and how to control my anxiety - social anxiety.

I constantly reflected upon how good I felt about having accomplished so much. Over a decade of hard work had been invested in getting me here where I am in my late 20s.  

It also seemed that when you do demonstrate respect for others, empathy, and concern, they want to talk about their experiences. That was my observation time and again. Chris recognized my growing talent and eagerness and let me start doing some brief therapy with patients. Because the patients were not in the hospital very long, the therapy had to be brief.  

Chris gave me some pointers as to what I might want to do when I sat down with a patient - what kinds of interventions might be helpful. I discussed what I had been learning in my classes and other studies. 

What might I do in a session with a patient? Well, if they are dealing with major depression, we could try Cognitive Behavioral techniques where we learn to challenge automatic thoughts that create negative emotions.

With trauma issues, deep relaxation techniques are very helpful in talking about a disturbing event. I would demonstrate or guide a person in the use of guided imagery and deep breathing to create relaxation. 

By that time, I was clearly demonstrating empathy and powerful listening skills. I received that kind of feedback from Chris when I turned in notes about my activities, but I also had that impression from the feedback that I received from the patients. I’m not saying they gave me a score on empathy and listening skills but there were so many times when I noticed how much people wanted to share their stories and feelings with me.

There were various opportunities when I was on the unit where patients had a chance to approach me and ask to talk about an issue that had come up in a group or from our earlier conversation when I did the intake assessment for example. Sometimes all I did was just listen with empathy. The experience of being in the hospital is not likely to be a pleasant experience. 

This kind of listening may not sound like a technique but in the psychological theories that were developed by Carl Rogers, unconditional positive regard and empathy are valuable tools.

I would tell them when I met with them for therapy that I was going to write up notes about what we discussed in therapy to see if it could be helpful to others who might be offering treatment for them. I instinctually felt that I could and would offer to let them tell me something and ask that it not be recorded in the notes.  

Gender issues were never relevant. I mean the fact that I was male was not a factor in a patient choosing to disclose any details about what they had experienced. Sometimes you might think that a woman might only talk to another woman about something traumatic, especially if they were victimized by a man.  

What probably intrigued me the most was the experiences that people with schizophrenia or psychotic disorders might be having. I thought that if I could demonstrate empathy, understanding, and compassion, and be able to help people struggling with these issues that would be something amazing. 

In seeking to help someone with a psychotic disorder, treatment might include active listening which means summarizing or rephrasing what someone just said to see if we can understand one another. That connection is so important. It’s sad but some people with schizophrenia will develop serious problems with communication and what they say might not make any sense. I believed I was making a difference by listening and trying to understand.

There is a great deal of research that demonstrates a genetic predisposition for various psychiatric disorders. However, it seems from my own experience that being confronted with major life stressors, even stressors that might not seem like traumatic events, and any person can develop a range of different symptoms – hopefully, that is temporary. 

I did file away the observation that so many people were coming to the survivor groups, even though trauma was not an issue that necessarily had an impact on why they were admitted to the hospital. 

Often Chris was present in the group sessions even when he allowed me to lead the group. I would talk about relaxation techniques as Chris had done. I would employ the kinds of guided imagery exercises that were used in the groups that Chris led, meaning, I invited them to follow along with my suggestions or guidance.

I know that I have covered a great deal here and may not have been overly specific when describing theories and techniques or what I specifically did. I'm not trying to give psychology or psychotherapy lessons, per se... but I will go into greater detail later in the book.  

My second internship would prove to be the most rewarding. All in all, during my second year of full-time graduate studies, I was feeling good about every aspect of my life. I was doing great in classes, in my internship, and at work.    

A master’s in social work is a two-year program and so the second year is our final year. As I was saying, during our second year, we take classes and work in a setting that closely matches our primary interest area for where we want to work upon graduation.  

An Epiphany - An Answer to a Question

I wanted to start with an insight that I had gained during a class that was titled "Abnormal Psychology." I touched on this a bit earlier, but I wanted to add a few things. Anyway, in this class, we studied and learned about the entire range of psychiatric disorders as they are described in the DSM-IV (the Diagnostic and Statistical Manual of Psychiatric Disorders, fourth edition).  

We used a big book that is used by psychiatrists and other mental health professionals to make a diagnosis.  

Anyway, when we started covering personality disorders, that's when I had an epiphany.

We were considering public figures as examples of people who may have a particular personality disorder. Some people on YouTube seem to walk on eggshells when it comes to speculating about the disorders of public figures. I don't think our professor was quite so worried about making an error in diagnosing someone. I suppose our professor wasn’t speaking to a large audience nor was he making a definitive diagnosis. 

I remember we discussed OJ Simpson as an example of someone with Narcissistic Personality Disorder. We were also encouraged to consider people we might know who might have a variety of different personality disorders. The thinking was that this would make things more clear and easier to understand.

There are some rules in the US that discourage diagnosing public figures. Those “rules” do not seem to be hard absolute rules. 

With regard to personality disorders, it’s not rocket science nor is it necessary that you sit down with someone to make a diagnosis. Another argument is that the person being diagnosed should be seeking treatment. Sometimes people are involuntarily committed to a psychiatric hospital and so they didn’t seek treatment or a diagnosis. 

Mental health professionals make observations, gather information from people other than the person being diagnosed.

Anyway, it was in this class when it hit me!

Narcissistic personality disorder (NPD) is the problem that my mother had. The questions that had racked my brain for decades finally had an answer or an explanation. I don't know if this diagnosis of the problems that Kathy Whealton had would have been helpful earlier but at least I had a sense of clarity as to what was wrong.  

In many ways my father, Bruce Sr. seemed to have the same condition. It wasn't so obvious with him though.  

It was obvious that my mother could not see things from a different point of view.

That is the difference that I noticed with my mother. She NEVER could come forward and say, "I am sorry for the way I acted... that was wrong."  

There is more to it than these observations. Both parents had a condescending and judgmental attitude toward others. Only certain "special" people could meet their high standards for being worthy of their attention. 

These are symptoms of NPD or characteristics of a narcissistic family. 

Anyway, I do not say these things with an angry heart. Nor is this an effort to make my parents look bad. This epiphany was an answer to a question I have been asking for the past 15 years or so. 

Getting back to the topic of second year graduate studies.

We had courses that covered a variety of techniques for group, individual, family, and couples therapy/counseling. I won’t give you an education here into a typical second-year graduate program in social work. While learning the “basics” we were also encouraged to learn more about certain theories, therapies, and techniques. This is not unlike the way that psychotherapists will specialize in the use of certain types of therapy that they do best. No one can know everything about every form of therapy. 

In graduate school, during our second year, we take classes that ask us to research different treatment techniques and therapies. For example, in one class I did a long paper on treatment options for people with dual diagnoses like a mental illness and a substance use disorder. I felt that the 12-step programs of Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) had some limits and potential flaws.

My concern with NA/AA is that people get advice from others who have no specialized training. On top of that, I had noticed from the literature that these people will tell a person that the main and primary consideration is to avoid the addictive substance. That discounts a person’s overall suffering and pain.

So, I looked for recent scientific journal articles that presented research findings that might be relevant to this topic. I remember my paper was 30 pages long.

I was learning about a variety of treatment techniques and theories. 

My Internship at The Oaks

During this second year of my education, I did my internship at "The Oaks" psychiatric hospital under the guidance and supervision of Chris Hauge. Yes, he is the same Dr. Chris Hauge that I mentioned when speaking of my volunteer work at "The Oaks" in an earlier chapter.  

The doubts that I had during my first year, however infrequent they were, now were non-existent. I had no doubt that I had made all the right choices to get me here finally. Chris had worked in the field for decades, longer than anyone I ever knew, and he was very well respected. 

Chris was happy to have me do my internship there at "The Oaks" as we discussed previously. He saw my passion and drive to help others who were hurting, in distress, or having problems in life. He nurtured that hunger and drive giving me opportunities to do the things that I wanted to do... For example, it wasn't long before I had a chance to do some therapy with patients in the hospital.

I was participating in groups led by Chris - therapy groups.  

What I loved about the way Chris did the groups is that the "staff," psychiatric nurses, other interns, medical students, and others were expected to participate in the group. What I mean is that they were not there to just observe what others were doing.  

I'm going to have to be more specific to describe what I mean. Patients were in the hospital in most cases for no more than about two weeks. So, we had to figure out what could be accomplished in a brief period of time. Chris happened to be skilled in the use of experiential therapy techniques, which I will describe below.

Let's consider some examples. In a relaxation group, we might talk about natural ways to relax and deal with anxiety. In a survivor's group, we would start with deep breathing for relaxation and then Chris would guide us into a guided visualization exercise with our eyes closed. As an example, we might visualize a younger version of ourselves sitting in a chair in front of us.

It was really powerful and amazing. As the name implies, a survivors’ group was for those who experienced abuse and/or trauma. This younger version of ourselves was our wounded inner child... or it could be a younger version of ourselves when we were younger adults. 

Technically, it’s important to note that we were younger a month ago and if something traumatic happened at that time, we would say that we were psychologically wounded. We could also call this wounded inner part of ourselves an “ego state.” It’s almost as if a part of our “self” is frozen in time. Our task is to help a person move past the experience and find closure.  

The use of self-disclosure was also encouraged by Chris. That means that the staff or a group leader will share personal details about themselves. To me, it seemed that this would encourage or make it easier for patients to open up as well.

Think about it. You are a patient in the hospital, maybe there against your will if you were committed involuntarily. For whatever reason, you decide to go to the group to see what is happening, and maybe in the back of your mind, you are thinking that you were hurt at some time in the past and it still bothers you.  

As long as you don't have to talk about it, you will come. You enter the room with chairs that are in a circular formation with an opening in the middle. You are invited to close your eyes and take a few deep breaths. Everyone closes their eyes including those wearing a staff badge/id. So, you feel safe, and something happens.  

What happens? Well, this is called experiential therapy and experiential is a word that is easy enough for the patients to understand because it means what the name says. This is about creating an experience. It's non-directive in the sense that no one is telling you what to focus on or making suggestions about what did or did not happen that was meaningful to you.  

I was able to observe that the therapy did have positive effects on patients during the sessions. This was evidence from the direct feedback from patients during the group therapy sessions and by observing their facial “affect” – displayed emotions.

What was intriguing for me was that people who were in the hospital with a wide range of different diagnoses seemed to be coming to the survivors’ groups and working through past trauma and abuse. The idea that mental illness is only caused by chemical imbalances that occur just because of some genetic predisposition alone must be questioned.  

At the very least, some stressors in life seem to be able to create symptoms that one finds in various disorders.

I began graduate studies at the University of South Carolina in September of 1993 as a part-time student for the first year. This was prior to Lynn and I getting engaged and then moving in with each other.

With my past experience mainly as a volunteer working with the social work team at a psychiatric hospital in Georgia, I was able to get letters of recommendation that were necessary to get into graduate school.

As I think of this, I worry about how I am portraying Lynn. She wasn’t a housewife, homemaker, or anything like that. I didn’t come home and say “honey, I worked all day can you cook me dinner?” She wasn’t living through me and my successes.

As I mentioned previously, she had to keep her income below a certain level to qualify for health insurance to maintain her health and stay alive. That meant limiting her work hours. She did some office-type work and used her proofreading skills. Of course, she had her pottery as well.

She wasn’t sitting at home watching TV while I worked, went to school, and did my internships.

Anyway, after gaining admission to the school in the fall of 1993, I found out that there were a few classes I could take part-time through distance learning. Instead of traveling over three hours to Columbia, South Carolina, I only had to travel to the campus in Conway, South Carolina which was about an hour and a half away. 

This allowed me to continue to get experience working directly with people in the human services field. 

Going part-time wasn’t a “real” college experience. I sat in a room by myself in the evenings. Sure, we could pick up a phone and interact a bit, but it was nowhere near as rewarding as full-time studies with other students in the same room. 

Full-Time Graduate Studies in Social Work

I began full-time graduate studies in the fall semester of 1994.

This was still, obviously, at the University of South Carolina but now I was going to Columbia, South Carolina. This was a three-hour drive from Wilmington, North Carolina. I would drive down on Wednesday and stay in one of the dorm rooms. I would then check out the next day and go to class on Thursday.  

Three back-to-back classes, that were just under three hours long. Hardly a break between classes.  

On Monday and Tuesday, I had my internship. An internship isn't paid work. So, I had to borrow money to cover living expenses, books, travel, and other expenses.    

The Stafford Loans are designed to cover a scenario just like this. During the summer between what would be the first year of my studies and the second, I was able to pick up extra hours working as a paraprofessional.  

Anyway, this was like night and day from my earlier days in college when I had been so shy and quiet. I suppose I was anxious to share my thoughts, speak in class, participate, ask questions and learn as much as possible. That is what I was doing.

I was psyched. This was happening for real! My dreams, my goals, were coming true. 

During the first year, you study both macro and micro-level social work practices. Some colleges call this direct and indirect services.  

Macro-level social work addresses issues that can be looked at from the level of a community, an organization, an agency, or government. So, we learned about the history of social welfare in the United States. Of key importance among the programs that stand out or the periods in history are the FDR years and the "New Deal."  

In terms of macro-level work, we were expected to do a "needs assessment" for a community where you are living. Through my work, I had identified a low-income community that was partially in the historic district of Wilmington not far from the Cape Fear River. I had also been going to a gym in that area. It was a boxing gym, but I wasn’t a boxer. I just went to work out. It wasn’t far from one of my internship placements. 

That area contained a great deal of public housing which is by definition set aside for the poorest individuals and families. Demographically, it was also predominately populated by African Americans.  

While this was macro-level social work, I did get a chance to develop relationships with “community leaders” and similar folks who knew the area and could share information with me.  

With this information, we were tasked with writing a paper that describes the area and the needs that exist in the community. We were also encouraged to present photographs that illustrate important aspects of the community and their needs.

During the second year, we focus on our choice of either micro-level or macro-level social work. Micro-level social work is about providing direct services to individuals, couples, families, and groups.

I remember the theories that guided micro-level (direct) social work practice more than those ideas or principles that define macro-level social work because my specialization was in direct (micro-level) social work. This is what therapists/psychotherapists may do. We provide direct services (treatment/therapy) to individuals, couples, families, and groups.  

There is a range of different pioneers, psychologists, and psychiatrists that have provided the therapies, theories, and techniques that professionals use. I will describe this later in the book.

First Year Internships

Finally, in considering this first year, I want to talk about my internships.  

During the first year, we are expected to work in a setting that is distinct from the setting where we would like to work during our second and final year internship. The second-year internship is intended to be a reflection of the setting where we would like to work primarily in our career upon graduation.

For me, as indicated previously, I intended to work at The Oaks with Chris Hauge, DSW (my mentor). This kind of psychiatric setting has been the kind of setting where things have been the most rewarding and interesting to me.  

During the first semester of my first-year internship, I worked on the children's unit at the mental health center for New Hanover County in Wilmington.  

Things didn't go as well as I would have liked. It was discouraging. This was the first time when I felt like I didn't have the necessary direction and guidance to be successful. I didn't want to be in a setting where I was uncertain about what to do and feeling lost.  

I was a bit hard on myself and expected that I should have figured out what to do. Often, work with children will involve "play therapy" which is harder than it seems. I had no training yet in working with children and I wasn’t getting guidance from my supervisor or others.

I was torn between unreasonable expectations and doubts that I couldn’t just figure things out. I didn’t think they wanted me to come in and just “play” with kids. I suppose it took me some time to get comfortable with the realization that this wasn’t a good match for me. If this wasn’t a job or an internship, it would be great spending time with kids.

You might recall that I had been like a big brother to a girl who was the child of a couple that was friends with my parents. That was so much fun, with laughter, and just hanging out with her. I was the same way with my relatives who had younger children when I was growing up. Often, I was the one who entertained the kids while the grownups socialized.

Doing an internship working with children felt so different to me than spending time with children outside a treatment setting. So far.              

During the second semester, I was placed at the same organization but in two different departments. In the mornings and early afternoons, I worked at a day treatment program for individuals with chronic and persistent mental illnesses. In the afternoon, I worked with the homeless program that was staffed by the mental health center.  

Some of the time I was able to participate and get to know those who came to the day shelter for the homeless. It was interesting because there were classes that covered mental health issues and the format was something like a support group/therapy group.  

I remember seeing in the morning at the day program for individuals with chronic and persistent mental illnesses, some of the same folks that were residents at Sherwood Village where I worked on the weekends.  

Anyway, that need to prove myself didn't go over so well in one instance. I somehow spoke out of turn and corrected someone accidentally about something from the DSM – the Diagnostic and Statistical Manual of Mental Disorders. I was trying to demonstrate my knowledge, but I was not in a classroom setting. So, my supervisor corrected me after that.  

It was disturbing to me that I was having some troubles during the internship placements that I had. Only occasionally did I feel like I was doing something useful and important. I guess I also still had things to learn in terms of social skills. 

Mainly, I felt discouraged. I had switched out of the children's unit/department and given two placements with two other departments. The reason for me to be placed in two departments was to allow me to get the hours required. I don’t remember all the little criticisms my supervisor had done to correct me, but it made me feel discouraged and sad. I had so wanted everything to go right.

My supervisor during that second semester once asked me if I was really had the potential to work in social work. That was the first and only time I have heard that in my career/life. If a job didn’t go well in the future, it was not for reasons related to my skills as a social worker.

The afternoon placement went okay in terms of my interactions with the staff and my responsibilities. It just seemed that I wasn't needed as much as I wanted to be needed. There seemed to be limited opportunities for me to do things.  

I did develop a "street sheet" that would be useful for the homeless in Wilmington. I used our computer at home and the bus maps. Various resources were marked on the map on one side and on the other side there were descriptions of the various resources and services.  

An Unrecognized Foreshadowing…

Years later when my life had become a living nightmare, I would be given that same "street sheet" I had developed… a time when I was homeless and alone.

However, at this time, I had no knowledge of what was coming years later.

Anyway, during this first year, and similarly during the second year, as you can see, I had a very busy schedule.    

Monday and Tuesday I did my internship, then I slept late on Wednesday and drove down to Columbia South Carolina, stayed overnight in the dorms, and went to class on Thursday. Then on Friday evening through Sunday evening, I worked at Sherwood Village.  

On top of that, I had papers and homework, of course. I was extremely motivated to prove myself. Part of me was trying to prove my competency to myself. Self-doubt is very troublesome.  

Despite some challenges and doubts, this was a very rewarding experience and overall, I loved where I was in my journey. I especially loved what I was learning in my classes and I loved the work that I did at Sherwood Village.  

That job didn't require my attention during the entire 48-hour shift. So, I was able to bring my books from classes with me and read. Sundays were especially slow days so I could catch up on my reading.  

There was one other job that was very rewarding and fun. I worked the weekend shift at Sherwood Village, an Independent Supportive Living Apartment Complex. There were roughly 30 apartments that housed 30 individuals.  

I was on-call with a beeper for a 48-hour shift from Friday at 6 PM until Sunday at 6 PM. It was a supportive independent living facility in the sense that everyone lived independently but someone was on staff 24 hours per day 7 days per week. This was a place for persons with severe and persistent mental illness. It was called Sherwood Village.

By now I was a graduate student with so many other responsibilities and things going on in my life – a life with Lynn.

I was responsible for transporting the residents to the movies or other similar events. They had a van for me to transport the tenants. I didn't go with them to the movies most times because tenants that chose not to go on an outing might need my services.  

I was allowed to go home with the pager that any of the residents could call if they needed me.  

It was a great job, and I was well-liked by everyone. I stayed on with this position until I got my master’s degree and could move up into a more professional level position.  

It was fun to get to know all the residents. They said they liked me better than the staff member who worked from Sunday at 6 PM through Friday at 6 PM. So, that felt good to know.  

The only activity that I had to do as someone who is "in charge" was to do some inspections of the apartment - mainly that was inspecting the A/C filters and other things like that. Obviously, there were some things that are important to promote a person's overall health that I had to oversee.  

They knew I had a job to do for the landlord and the managers that maintain the apartments. I obviously had to make sure people were okay, but it wasn't like in a hospital unit where someone might come by every few hours. Most tenants were relatively high functioning, so they weren't going to wander away and disappear.  

They had their own cars in some cases and there was no curfew or anything like that.  

It was extremely rewarding because I NEVER had an issue with any of the tenants not liking me.

This would be a common theme in my career overall where the greatest challenge was with paperwork/charting, bureaucracies, staff expectations, and in my role as a member of the staff. 

During this entire decade and into 2000, I NEVER had negative feedback or opinions expressed by anyone I served or helped – with clients, patients, or tenants everything went so smoothly. 

The job was awesome overall. I mean I was getting to know these people and feel like I was part of a family. I considered them part of my family in a way. I mean I liked everyone there. One or two residents were distant and didn't talk much but most everyone was great to know.  

I didn’t think the staff for whom I was working had too many rules. I was on my own for most of the entire weekend and for most weekends. The only people contacting me were tenants/residents.  

I could visit them inside their apartments. Obviously, that could be problematic with female tenants, but it never became an issue. If there was more than one person in the apartment, I didn't feel too concerned about spending some time in any of the tenant's apartments. Sometimes there were emergencies, and that required spending extended time with a particular tenant who was in a crisis situation.  

These crises rarely happened. I do remember one woman having a seizure and I was on the phone with EMS. I had to return to Sherwood Village because I had gone home with the pager when I got the message to call the tenant's phone number.  

Residents of Sherwood Village had disorders such as schizophrenia, Major Depression, Bipolar Disorders, and so on. These disorders were characterized as severe and persistent mental illnesses. That is likely a designation that is necessary to obtain funding.  

I obviously was made aware of the diagnoses of each resident. I also had to know what medications they were taking, physical problems, and other important information. This was all on file in the office. I was given a couch in the dayroom or I could sleep on the couch in the office if I needed more privacy at night.  

I ran the tenant meetings which were held about once a month. Most of the tenants came for the meeting that was held in the dayroom which was a place where people could visit during most hours such as 9 AM to 9 PM. I could certainly spend additional time with tenants in that room if they needed to talk to someone.

Hopefully, you can imagine why this job was awesome for me. And why they all felt like my family.  

It also is important to note how comfortable I felt running the tenant/resident meetings. Unlike reading my poetry to a group, this was more like directing a group event.

Yes, I felt so comfortable interacting with everyone as the person that everyone turned to for help whatever their problems were. I was starting my graduate studies during this time period, so I had been learning other skills in college (graduate school) to help me in counseling individuals in need and how to run group sessions.  

I wasn't actually doing therapy yet but some of what we do as therapists is to listen to others with empathy. To help people feel safe. To be someone who others turn to for help and support.  

We also had a Christmas party on the weekend when I was there. It was so nice. I felt needed and important.  

It felt so right. I mean I was doing a great job, and I could tell that I was. I could tell that I was someone that people felt very comfortable talking to. 

I also know that I was more liked than the young woman who worked there during the week.  

I also have no doubt that both the men and the women felt more comfortable talking to me about anything than they did talking to Donita, who worked during the weekdays. I knew that people there were glad to see me arrive on Friday - they told me.  

What people most want, and I can speak from experience is someone who truly listens and demonstrates empathy. Notice that I said, "demonstrates empathy."  You cannot just feel comfortable believing you have empathy for another person and their situation. People will let you know how they feel when you are working with them or they will be distant, closed off, or reserved as they had been with Donita.

It seems like common sense that people won't be coming to you or repeatedly seeking your help and support if you are not demonstrating empathy. People here were coming to me to discuss everything that concerned them. 

I felt a powerful connection.

Donita seemed to be held out as a role model for me by my supervisor at least until he started talking to the tenants about me.  

The tenants on the other hand did complain to me about Donita’s "attitude." She wasn't approachable, I was told. It wasn't anything that was serious enough for them to complain, for the most part.   

It's important to note that some people in a situation like this do not feel empowered to complain. Having a chronic and persistent mental illness carries with it some stigma and it doesn't lend itself to creating feelings of self-esteem and self-confidence. Low self-esteem can go hand-in-hand with various psychiatric illnesses.  

That being said, I know I made a difference and the tenants at Sherwood Village didn't want me to leave when I had to move on with my career and take on more professional opportunities. That was happening as I completed my graduate training.          

Unfortunately, due to confidentiality, I could not ask them for letters of recommendation for any job outside the mental health center/clinic. I did have complete confidence that each of the tenants, when and if asked about my performance had nothing but good things to say.  

In the next chapter, I will begin to discuss the next stages in my education. More specifically, I am going to discuss my graduate studies at the University of South Carolina in the Department of Social Work. 

Prior to starting graduate school, there were limits as to what I could do in the field. I was not able to work as a mental health professional yet. However, there are jobs where one can work as a para-professional.  

I found opportunities to do work with clients who have developmental disabilities as well as in some cases, mental illness and/or physical conditions/disabilities. There has been some overlap between the fields.  

The Mental Health Center in New Hanover County was also the Center for Developmental Disabilities.  

With my job ending at Corning, I had to find other work. I had been spending all my time with Lynn and my self-esteem had grown tremendously as a result of that relationship and as a result of the experience, my time with Celta before that, and my various experiences as a volunteer in the psychiatric field.

I'm not saying there were not struggles, worries, or uncertainty. Had my mental health not improved from where it was before I moved to Wilmington, I might have been more panicky about the job ending after six months.  

Instead, I just looked for opportunities and bounced ideas off Lynn. It was very helpful to have someone who could hold me in her body... someone I could cuddle up next to whenever I was anxious or fearful. Plus, she was very practical, as I described earlier, so I felt confident that I could find answers and solutions to meet the challenges I was facing, whatever they might be. 

As I was saying, I needed to find employment after the job at Corning ended. I had worked as a technical writer and had saved up a great deal of money in just six months. Since the job was contracted through an employment agency in Augusta, Georgia, the salary was paid as per diem – similar to when a company pays you for going to a conference. This way most of it was not taxed at all!   

Eventually, I found a job with an agency that treats individuals with developmental disorders such as autism, and various levels of mental retardation. The latter is measured by results on IQ tests when a person scores at least two standard deviations below normal - which is an IQ of 70 or less.  

I started working with a client who had autism and some degree of mental retardation. I met him at the day program that existed in Wilmington and which was affiliated with the Southeastern Center for Mental Health/Developmental Disorders/Substances Abuse Services. Adults would come for several hours to the facility where they would be taught various skills for coping in the environment.  

The guy I was working with was very big, about twice my size, and he could not speak as a result of his condition or disorders – that is commonly the case for individuals with autism. He used sign language. So, I had a chance to learn sign language. It was so very important to be able to sign various words to communicate with him. 

I had goals and things that I was supposed to do with him every day. One such goal might be to accompany him for walks around the area. Obviously, I had to make sure he didn’t run out into traffic so I mainly walked on the sidewalk closest to the street to ensure that this would not happen. 

He also had a problem with repetitive behaviors where he would swing his arms and risk injuring himself. This is troublesome because I was afraid that he would hurt himself. No one spelled out what exactly I should do when this happened. 

 There was at least one other individual there who was a client of the same company and I worked with him as well. 

I knew that case managers had developed the goals which were put into a treatment plan that I was responsible for implementing. I also knew that case managers are usually social workers – not typically social workers with an MSW (master’s in social work).

I wondered if I was helping these people. I knew I was helping their families, but I wasn’t getting direct feedback from the clients I was serving.

Jumping Ahead To When Lynn And I Were Living Together…

The relationship with Lynn was growing, I was beginning graduate school and working several jobs. 

In late 1994, Lynn and I moved into a nice neighborhood in northern Wilmington, and one of the clients with whom I was assigned to work lived in that neighborhood. I worked with him through the Southeastern Center for Mental Health/Developmental Disabilities and Substance Abuse Services and with a company with whom they contracted.

This client’s name was James. 

I worked with James both in the community and at his home. James lived in a home that was staffed 24/7 – all the time every day. Unlike a “group home,” he lived in a home where the rent was paid by the state as were the staff and other services that he received. 

I had been “networking” with employees of the Southeastern Center for Mental Health/Developmental Disabilities/Substance Abuse Services as well as agencies with which they contracted for direct-care services to clients. I worked at group homes and in the community including at the Day treatment center as I described earlier in this chapter.

While James had his own residential placement, I was also working at other residential locations where individuals with a mental illness and/or developmental disability were staffed 24/7 365 days per year. A “shift” at these residential locations was 8 hours straight and you had to bring a meal with you or eat food that was available for staff because sometimes you were alone on duty. 

James was unique and that’s why he had to be placed by himself instead of with others at a “group” home. He had Cerebral Palsy, Intermittent Explosive Disorder, and an Intellectual Disability. I can’t give his last name for confidentiality purposes.

"Intermittent explosive disorder" is just what it sounds like.

I had to learn how professionals in the field restrain a client who might get combative. In all my years of experience that only has been an issue in cases in which a person has a developmental disability like autism or some form of mental retardation and a mental illness. 

Unfortunately, when you combine intellectual disabilities, problematic or limited social skills, and certain psychiatric conditions, there is a potential for aggression. 

A foreshadowing of things to come…

As an aside, it is possible to be hurt by someone with a mental illness without the mental illness causing a person to hurt you. I would learn that many years later, when things happened.

I started working with James shortly after Lynn and I moved into our home on Brucemont Dr. This would be OUR home for years after this.

Getting back to working with James…

Our goals with James were to help him to fit into the community and to go places within the community. This could include the library, restaurants, the park, the beach, shopping, and maybe the movies among other things. 

At least, I knew that these were goals that James desired. The challenge was to teach him socially appropriate behaviors, so we didn't get thrown out of places where we went.  

Indeed, that was a challenge. He was the opposite of shy. He would approach anyone and everyone and start talking to them as well as a great deal of touching – potentially sexually inappropriate, hugging and putting his arm around people. Everyone. And he was loud. So, everywhere we went he knew people and he would hug them or otherwise touch them. 

James loved to see Lynn when I took him by the house where we were living. As it turned out his residence was less than a quarter-mile from where we lived.

I didn't leave James alone with Lynn because he might get inappropriate. I am sure he saw me as more than just a staff person giving him directions about how to act appropriately in a particular setting. He saw me as someone who would protect Lynn from ANYTHING that bothered her. 

I did get approval from Lynn and confirmation that she was comfortable with me bringing James there. 

I didn't disabuse James of the notion that I would treat him the same way I would treat anyone who dared to do anything Lynn didn’t want them to do. He would struggle to keep his urges in check… moving to touch Lynn on the shoulder and then start to invade her personal space. Lynn would put up her arms and say “James!”

I wasn’t far away, obviously. Instantly, I looked up and James would look at me. Then James would say “uh, oh, he’s mad now” with an uncomfortable, low rumbling laugh. 

I’d say, “Okay, we are leaving now.”

Lynn would say “he’s okay, right James?”

“Well, we need to go anyway,” would be my response because he had to learn. I was a bit uncomfortable whenever he did these things but not everyone was as forthcoming and understanding as Lynn.

Then Lynn would say “when will you be home, honey?” and Lynn would give me a kiss, unaware of what kind of reaction this was eliciting in James. I knew from his low rumbling laughter. 

He wanted another hug or something. So, I would turn and guide him out the door before he or Lynn knew what was happening.