Being A Psychotherapist: Things School and Books Can’t Really Prepare You For Part One: Mental Fatique

iStock_000024633998Medium-744x418To be a psychotherapist takes years of school and a lot of reading and writing about various aspects of human behavior. Many students fresh out of school with not much patient contact or real therapeutic hours under their belt, think that they fully know what it is like to be a therapist. They don’t. While school and books definitely prepare you for sounding like a trained therapist, nothing but real experience and hundreds of hours of patient contact, can prepare you for even the basics of what it’s like to be a therapist.

Many people who see me doing my job say, “I want to do that” and I never discourage them. I just tell them that if they are doing it from their hearts then they should pursue it. If they are doing it because they think it pays well, then they should seek another career. If they are doing it because it looks easy, then they should definitely seek another career. Even students who have spent years in undergrad and then graduate school are disillusioned and thus disappointed when they actually start seeing clients of their own. A few, those meant to truly be in the field, will love it, even when it’s frustrating. Others will hate it, but stay because they’ve fooled themselves to believe they are supposed to be therapist, and most end up becoming very bad therapists… or program directors. A large portion will leave the field altogether and seek employment that is more fulfilling and they should.

So what are the things that school and books can’t prepare you for when it comes to being a psychotherapist? Well I will cover one topic every now and then instead of trying to cram a top 10 list, but we’ll start with mental fatigue.

Being a psychotherapist is exhausting. Sure it’s not the same as lifting bricks all day, but it’s a different kind of exhaustion. People will say, all you do is sit and listen all day, how can that be exhausting. Well actively listening, being thoughtful, sustaining alertness, using your memory and paying attention to someone for 50 minute stretches throughout the day is very draining. Not to mention the stories you hear and have to process. Stories that are sometimes so sad that you have to hold yourself back from tears, or stories that trigger counter-transference issues because they remind you of some part of your own life.

There is also other things that make it taxing such as doing notes, scheduling, dealing with insurance companies and billing. There’s also that part about managing risks, having to figure out how much of a risk someone is to themselves or others. My main job right now is assessing suicidality in inmates who have exhibited a risk for suicide. It can become very stressful.

On top of that, sometimes your friends and even strangers who meet you and find out you’re a psychotherapist will treat you differently.

Strangers will either be fascinated and want to tell you about their problems, or a “friends”, or they will not talk much out of fear that you are always analyzing people. We do know how to turn it off, well at least turn it down. Your friends will most likely have you as their default free therapist, yet will not offer you much advice/help since “you’re a therapist, you should be able to figure out your own problems.” Oh, I’ve heard that too many times.

It can be exhausting because being a therapist, once you’ve done it long enough, becomes who you are. You don’t leave it behind at 5pm, even when you think you do. It’s always there with you and if you aren’t careful and don’t take care of yourself, it will drain you.

The link below is to a very well written article that details some of the hardest and most exhausting parts about being a therapist.

The One Thing Every Psychotherapist’s Partner Doesn’t Get.

Tips for College Freshmen

istock_000004524452small-520x487It’s that time of the year again when students of all ages are headed back to class, but for college freshmen, this time of year can be full of excitement and loads of anxiety that can send them packing back home or spinning into a dangerous cycle of poor choices.

A few of the high school clients I worked with last year are feeling this same since of angst so I wanted to share some of what I have shared with them about creating an environment for success their freshmen year of college.

Live Like a Broke College Student

Sometimes when students go off to college they forget that they may not have the constant source of income they had while they were home, and yet there is more things that they want to do that cost more money.

College is expensive. Take advantages of free things, there are usually a lot of free things on campus from food to clothing.

Students have to learn how to live with less funds which means learning how to budget, given up some of their favorite meals or even activities. They will have to learn how to survive with less, which is a challenge, but it can be fun and creative. College student are notorious for coming up with inexpensive and free ways to have fun and that is something that should be embraced if you don’t want the lack of finances to be an added source of stress.

Don’t Be Afraid to Ask for Anything, Especially Help

A lot of times college is the first time young people are given total responsibility over themselves and many don’t know how to handle it. They think being an adult means you don’t have to ask for help, but that is where they get into trouble.

In college, you are treated like an adult. No one is going to remind you to read assignments, or to work on your paper, or to study. It’s up to you, so students need to learn to ask for help by being proactive in their relationships with their professors and not just thinking that the professor will let them know if they are not doing well in a particular course.

Building a support system is also crucial so that you have people you can turn to for advice, support and encouragement. A good support network should include upperclassmen, a professor they trust and look up to, as well as any administrators they feel they can turn to for advice or guidance.

Also, being part of a support group is extra helpful for students who need extra support or counseling, which is generally free on most college campuses. Asking for help is not about appearing weak, it’s about preparing for success.

Get Involved

When I speak to the college freshmen who are having the most difficult times adjusting, nearly all of them have done nothing to actually get involved or to get engaged on campus. It’s important to be open minded to both new experiences and people. Making real connections is one of the best ways to feel like you are apart of the college environment.

Many of the young people I work with who are college freshman come from the inner-city and sometimes feel out of place on college campuses where the majority of the student body doesn’t look like them. I always encourage them to join multicultural clubs and student support services in order to help them adjust and begin to engage with the entire student body.

At the same time, I let them know that it’s okay to take time to adjust and for them to not feel so overwhelmed if after a week or two they still don’t feel quite comfortable. The thing is, I want them to avoid feeling lonely which can lead to numerous issues including isolation, depression, poor grades and even dropping out of school.

Time Management

It’s good for college students to have some routine and a schedule that they can follow, but not a schedule that is so rigid that it doesn’t leave room for fun and other activities. Having a schedule such as when to study, when to workout, etc., can bring some order to a time that may appear chaotic.

This includes making time to take classes that they can manage and also allowing themseves to take a couple of fun classes like yoga or basketball, after all, it may be the last time they can take fun classes before they get into the really heavy stuff.

The first year of college is filled with lots of sometimes contradicting emotions, but being prepared to face those challenges will make it that much more exciting and fulfilling as well as prepared to accomplish all of their personal, social and academic goals.

Day of Silence

Boy-with-duct-tape-over-his-mouth-MG-9920Did you know that today is the Day of Silence? If you didn’t know, don’t feel bad because I was just educated about this last year by some of my students.

What is the Day of Silence? The Day of Silence is a nation wide, student led movement to bring attention to anti-gay, lesbian, bisexual and transgender (LGBT) bullying, harassment and name calling in schools.

Students across the nation from middle schools to colleges take a vow of silence to represent the silencing effect bullying and harassment has on LGBT students and those believed to be LGBT.

The event is sponsored by the Gay, Lesbian and Straight Education Network (GLSEN). Student use their vow of silence to speak up against anti-LGBT bullying and harassment.

I spoke with some of the LGBT students in my school who are planning on participating in the Day of Silence and they are all extremely passionate about it. All of them have been bullied, harassed, felt ostracized or misunderstood in someway and all want to stand up to against those who choose to treat them different from other people just because of their sexual orientation.

Many of them have gotten their straight friends to also participate in the Day of Silence by wearing duck tape (they chose red) around their mouths and not speaking all day. That’s a powerful statement and one I support wholeheartedly.

Often LGBT teens and  young adults feel so alone. This show of solidarity and support is extremely positive.

While students are encouraged to remain silent throughout the day, GLSEN doesn’t encourage classroom disruptions and makes amends for students to talk in class if a teacher insist that they answer a question. However, they also encourage students to talk to their teachers ahead of time for more positive and understanding results.

The day is supposed to be a positive educational experience, not a day of interruption. It’s a silent protest against the harassment and bullying that causes way too many LGBT students to miss school, have poor self-esteem and substance abuse problems, and even attempt and complete suicide each year.

I wrote a previous post about how young is too young to discuss sexual orientation which talks about the importance of the Gay Straight Alliance (GSA) and other support groups on campuses for LGBT students and those who support them. The Day of Silence is a powerful way to help other students and school administrations recognize the needs of LGBT students.

The Day of Silence doesn’t stop at the end of the day. GLSEN hopes that those who participate in it will continue to draw attention to the plight of the LGBT student body and community in positive ways and encourages schools to implement solutions that address anti-LGBT bullying and harassment.

GLSEN recommends schools:

  • Adopt and implement a comprehensive anti-bullying policy that enumerates categories such as race, gender, ethnicity, religion, sexual orientation and gender expression/identity.
  • Provide staff trainings to enable school staff to identify and address anti-LGBT name-calling, bullying and harassment effectively and in a timely manner.
  • Support student efforts to address anti-LGBT bullying and harassment on campus, such as the formation of a Gay-Straight Alliance.
  • Institute age-appropriate, factually accurate and inclusive curricula to help students understand and respect difference within the school community and society as a whole.

I know first hand from working with many LGBT students the painful affects that bullying, harassment and name calling can have, especially when they feel like they can’t voice their concerns to other heterosexual students, adults, teachers and their parents.

I encourage all of us, even if we can’t participate in the Day of Silence, to find one way we can stand up against bullying and harassment in any form, against any person, even if it’s as simple as intervening when we see it happening instead of  watching in silence.

How Young Is Too Young For Students To Discuss Sexual Orientation

istock_000009080325large-gay-pride-2009-news1Here in central Florida there has been an ongoing debate about how young is too young for students to discuss sexual orientation at school, especially when that orientation is different than the perceived norm.

Bayli Silberstein, a student leader at Carver Middle School in Leesburg, Florida wants to create a gay-straight alliance (GSA) at her school to combat ongoing bullying. “The bullying at our school has gotten out of hand, and somebody needs to do something about it,” stated Bayli.

While to me this sounds like something positive and something that should have been supported, the principal immediately shot it down and county administration put up a resistance so tough that they threatened to disband all groups if they had to in order to keep the GSA from being allowed to form.

They are taking so long to deliberate on allowing the GSA to form, while groups such as the Fellowship of Christian Athletes, an explicitly Christian organization, has been supported for years.

The fact that the administrative body is taking so long to deliberate on letting the GSA form, to me is even further evidence that groups like the GSA are needed. If the kids who are in need of support don’t feel supported by the very administration that is supposed to support and protect them, how are they supposed to feel supported and protected among their own student body?

Under the Equal Access Act, schools can not pick and choose which groups to allow to form on campus based on what they think students should and should not discuss:

 “schools may not pick and choose among clubs based on what they think students should or should not discuss. If a public school allows any student group whose purpose is not directly related to the school’s curriculum to meet on school grounds during lunch or before or after school, then it cannot deny other student groups the same access to the school because of the content of their proposed discussions. The Act specifically provides that a school cannot deny equal access to student clubs because of the ‘religious, political, philosophical, or other content of the speech at such meetings.’” 

GSAs are student organizations that are made up of lesbian, gay, bisexual, transgender students and their straight allies. The groups purpose is to advocate against bullying, discrimination and harassment.

Theyare made up of lesbian, gay, bisexual, and transgender (LGBT) students, along with straight supporters, who advocate for putting an end to bullying, harassment, and discrimination against LGBT and other students.

According to a  2009 survey by the Gay, Lesbian & Straight Education network,  “84.6 percent of LGBT students reported being verbally harassed, 40.1 percent reported being physically harassed and 18.8 percent reported being physically assaulted at school in the past year because of their sexual orientation.”

A lot of the bullying that goes on against LGBT students have Christian beliefs and teachings at it’s source and Christian groups are almost always very supported on school campuses.

Here in Florida, the ACLU has been successful numerous times over the years in helping students form GSAs on school campuses.

For example, in 2008 in Okeechobee, Florida,  a  judge ruled that schools must provide for the well-being of gay students and cannot discriminate against the GSA. The ACLU of Florida also succeeded in helping students at Booker T. Washington High School form a GSA after initial efforts were fought against by the administration.

At the high school I work at there is no GSA or LGBT clubs and it’s not because administration hasn’t allowed it, but because students haven’t attempted to form one. I think this is largely because sexual orientation is not discussed, yet admittedly, it appears to be pretty accepted on campus. Many of the LGBT students I talk to are “out” and have never told me they felt uncomfortable or bullied on campus.

While working on this post, I spoke with a 15 year old, openly gay student who says he knew he was gay in elementary school, but only really knew in middle school. He personally thought that having a GSA in middle school was too soon because he thought too many people were still unsure of their sexuality, but he also admitted that having a GSA in his middle school would have helped him with issues such as bullying and coming out to his family.

On other school campuses and in middle school in particular, being a LGBT student is likely much more difficult for several reasons.

Often times, school administration and school board members are not comfortable with the thought of students discussing sexual orientation. They are also often uncomfortable with discussing acceptance and respect for students of different orientations.

However, discussing topics that are uncomfortable, out in the open, is how change gets started, not by censoring students to avoid discomfort. That’s how the culture of secrecy and bullying is allowed to flourish.

Maslows Hierarchy of Needs And Why Some Students And Schools Are Failing

Maslow’s Hierarchy of Needs is based on Dr. Abraham Mallow’s research and hypothesis. It describes the stages we all need in order to become fully functioning and responsible adults moving towards reaching the highest possible achievements humans can accomplish.

Maslow's_hierarchy_of_needs

The hierarchy is broken down into five needs:

  • Self-Actualization           
  • Esteem
  • Love/Belonging
  • Safety
  • Physiological

The physiological needs is all the basic needs someone needs to survive such as food, water, air, homeostasis, excretion, and health.

The safety and security needs include security of:  body, resources, morality, family, health, stability and protection. At this level, all of the child’s physiological needs have been taking care of and they are interested in finding safety, such as from strangers. At this stage, a child develops a need for limits, order and structure. This is also the stage were fears and worries develop. The child may start fearing the dark, strange noises in their bedroom, or being kidnapped.

At the love and belonging level, the child needs others to love and support them, including family and friends. They need a sense of family stability in order to invest emotionally in others. If at this stage, it appears that no one loves or is stable enough to show a lasting commitment to the child, they may find it difficult to build future relationships or to even love themselves. This is also the stage where loneliness and social anxieties can develop.

At the esteem level, the child is searching for feelings of self-worth, confidence, achievement, mastery,  respect of others and respect by others. One one level, they may want status, a reputation and appreciation, and on a higher level they will need respect for their self, which is believed to be more important than respect for others. This is where some sense of independence and freedom start setting in, as well as potential issues with self-esteem and inferiority.

The four levels thus far mentioned were considered by Maslow to be deficiency or instinctual needs, meaning that if a child was deficits in any of these four needs they will be highly compelled to fulfill those needs. If however, all of a child’s needs are fulfilled at this level, they are free to move on to what are considered growth needs.

The growth needs are grouped under the level of self-actualization. They include needing to know and understand. This is what develops a child’s cognitive potential and is the level schools want each child to operate on. At this level, the child is able to listen, participate actively in discussion, attune, explore their thoughts and make meaning of the world around them.

At this level, the child appreciates symmetry, order and beauty. As they continue to grow, they become a fully functioning individual able to accept responsibility for their own life. They are well on their way to achieving their full potential and becoming the person they were meant to be. In the educational system, this is the main goal, to help children develop this part of their selves and nurture further growth in these areas.

The problem is, while schools in good areas with students from good neighborhoods usually function at this level, this is not the reality for many inner-city and impoverished students and communities. At good schools, students usually have had all of their four basic needs have met, while at poor, under-performing schools, many students haven’t had their basic needs completely met.

Often times the failing of many inner-city schools and students is blamed on teachers, when this is not always the case. I’ve been working in inner-city schools long enough to know that the teachers that work there are usually some of the most dedicated, educated and caring professionals you could ever hope for, but students still fail in large numbers.

When you look at the students, especially when you get to know them, you can see why failing schools are not always about teachers or the administration, but about the four basic needs that are not being fully met. These four basic needs have to be fully met in order for a child to even begin to truly gain benefits from being in school and a standardized educational system.

Many of these kids come to school starving or hopped up on foods that are full of sugar, but lack nourishment. They live in inconsistent homes and frequently either move or are bounced between relatives, and many live in dangerous environments from the home itself to the surrounding neighborhood. How then can we expect them to free their minds and focus on school when their basic needs aren’t even met?

Imagine a student starving becasue they didn’t get enough to eat the night before and didn’t get breakfast, yet they are supposed to focus and concentrate on an exam. When they do poorly, they are considered either a bad test taker, or the teacher is accused of being an inadequate educator.

Many of the kids in the inner-city high school I work at are simply surviving. They are trying not to get shot, attacked by people in their neighborhoods, kicked out of their home or help their parent pay the rent anyway they can.

One girl I spoke to came to school everyday with a knife because many girls in her neighborhood had been attacked by men and she was terrified she would get kidnapped, raped and killed walking home from school. It’s easy to think that this should motivate her to do well in school so she can get herself out of this type of neighborhood, but because her basic needs aren’t being met, she’s hyper-vigilante and anxious throughout the day with her mind pretty much on any and everything else except education.

I feel the frustration myself many times when I am trying to give a client the information and skills needed to overcome obstacles put in their way either by themselves or someone else, and they can’t truly grasp, let alone use the tools I am giving them because their basic needs haven’t been met and they are still stuck and starving for esteem, love and belonging, safety or physiological needs. I have to realize that much of what I am saying may be lost until they are able to attune and function on the higher levels of self-actualization.

Students and schools in these inner-city neighborhoods are compared to and expected to perform as well as students from schools and communities where their every basic needs are already met and they are free to focus on to the higher levels of self-actualization.

This is not to say that students can’t achieve some level of self-actualization although their basic needs aren’t fully met. I see that everyday, levels of extreme resilience where a homeless student who’s parents are in and out of jail is excelling in school, yet this is rare and one could only imagine how much more that student would be able to achieve if their basic needs were met and they were free to focus more energy on self-actualization, morality, creativity, spontaneity, problem solving, etc.

These inner-city schools are usually the ones that need funding the most, but because they are often under-performing,  they usually lose funding. This is something I never understood. “Failing” schools lose funding and “A” schools get more money. When funding is cut, social workers, counselors and psychologist are usually the first to be let go, even though they are the ones in the trenches helping these children work through their deficiency needs.

This goes to show that many people, especially those higher up who make the big decisions on education and legislation,  are clueless about the realities facing many school children in our country.  It becomes far too easy  to blame failing students and schools on teachers and administrations, who are often working harder and under difficult situations compared to teachers from better performing schools with better funding and support.

To effectively make changes, it’s not about moving under-performing students to better performing schools, or putting different, “better” teachers and administration in under-performing schools, but investing more in rebuilding poorer neighborhoods and families with psychological, social, emotional and educational supports. This of course takes more work and takes longer, but I truly believe the benefits are far more reaching and lasting.