Not in Ohio anymore

My first impressions of the counseling state of N_____ are influenced by my accoutrements (“I see by my outfit that I am a cowboy” – Smothers Brothers, possibly inexact quote).  One of them is the diagnostic assessment form used by the counseling agency that hired me as Independent Contractor.  It is a mere two pages and asks just a few basic, generic questions.  Past forms were intrusively detailed, giving a list of symptoms to endorse and explain, asked about hobbies, medical, friendships, strengths, weaknesses, risk taking, named illicit and other substance use to describe, specified abuse as mental, physical, sexual.  Etc.  And because the present Intake tool is so broad-brushed, I find myself seeing the client as predominately – and falsely – plainly human, not as the fused constellation, distillation, transmogrification of injured history that he or she really is.  To my surprise, my new approach seems preferable to me.

The old way led me to jump straight into the pus-filled heart of most clients, assuming – by my narcissistic ego – that I was right to focus on their poison, their walking dead or disabled.  But most clients don’t want to go there.  What would be worse than discovering, as adults, that their “older sister” was actually their mother (I recall such a case), would be to discover that ninety-nine percent of their life is running on, and away from, pain, that their functionality is an illusion that works – as it does work.  Sure, the classy-looking woman is a high-achieving professional with a lousy boyfriend.  But she really doesn’t want to know that she keeps him because she is needy of a man who can’t love her; that she avoids love.  It is far better, in session, to talk about his immaturity and lack of respect, and her children, in a breezy or serious way that assumes she is coming at them from an adult perspective.

My first impressions are also influenced by the incredible no-show rate of new applicants for therapy.  Though it’s only been a few weeks, close to seventy percent of those who set up an appointment for intake have no-showed and no-called.  Most of these are psychiatric hospitalization discharges, a population that we acknowledge wants to forget their problem as soon as they walk out the hospital door.  Still, the failure stats are absurd and make me wonder if there is something about this high-rolling state that raises its people to be flake-outs.  Give me time.

In the meantime, the weather is cold and beautiful and the ambiance is vacationy.  Palm trees, vibrant blue skies, stucco homes with tile roofs remind me of Sarasota, Florida, though where I am water is selective, scarcer and expensive.  I haven’t seen a bug yet.  Ha, Florida!

Future posts will, I think, be a surprise to me, as I feel it is time to investigate myself, you, and the field of psychotherapy deeper than I’ve gone so far.  I hope there will be more optimism, notwithstanding my piquant title.  Maybe my status here is a microcosm of this hoped-for change: I have plenty of time to think and be with all these no-shows.  That feels oppressive and scary, yet also balmy and imperially sweet – probably reflecting the molecular mess* that most of us are.

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* Search out this term to find several past blog posts addressing the messiness of the psyche.