Continuing with the discussion of my own "analysis," I would go and lay on a couch with Marjorie Israel - I believe that was her name, though it was 25 years ago. I was interested in the possible impact of my past and how it might come up in the form of counter-transference. This was an idea first proposed by Freud but later expanded. In my opinion, everyone who provides therapy should have some insights into these matters. Again, this was only one form of therapy that I was getting to improve my skills as a therapist.
Things were going great for me at Brynn Mar Psychiatric hospital in 1997. All the patients seemed to love me and I was being rewarded with this positive feedback. Technically, not everyone had to show up for group but it seemed that the patients loved what I was doing and were enthralled with me. I somehow came up with ideas to structure a group each and every day of work. That's quite a challenge. None of the patients would want to go over the same things or do the same things in the group every day. I had more than one group per day also.
The group sessions lasted from ninety minutes to two hours. Imagine trying to keep a group of 50 plus people occupied, interested, and motivated to come to the groups two or more times per day? I have seen other psychiatric hospitals take a different approach where they employ other modalities of therapy and other professionals to run therapy groups. For example, you might have an art therapist, a Recreational Therapist, an Occupational Therapist, and perhaps even a Music Therapist.
These professionals are great but not all such professionals have to have a graduate degree and they may not be required to take as many courses in counseling, psychology, or psychotherapy as a graduate student with two or more years of internship in a field like Social Work or Psychology. Note, I am in no way seeking to discount the skills and abilities of these professionals in their specific disciplines. They do great work and bring a great deal of talent to the healing process.
In this setting, the "therapist" was responsible for the overall treatment for each and every patient that was assigned to me. Again, half the patients were assigned to me and the other half were assigned to the other therapist who had the same graduate degree as me. As such, we provided group therapy, individual therapy, family therapy, or whatever might be appropriate. Family therapy was rare since this is was an inpatient setting. Case management was also the responsibility of the Therapist.
In one instance I was a bit disappointed that my supervisor was seemingly implying that I could not provide therapy for Victoria, mentioned above, because she needed to go to a place that specialized in Eating Disorders. The problem was that she had only Medicare or Medicaid and had used up the amount of funding that is made available to a person on these insurance programs. Also, there was no reason that I couldn't also provide treatment or therapy as she requested and required. They seemed to want to just get rid of her since they weren't going to get a great deal of money from her.
I had stated my concern that this setting was not providing a "therapeutic environment" for her and on occasion for others. I was not intending to be offensive but that was what they, the patients, had said and when I was asked if I agreed with that assessment, I stated that "yes, I think that is happening." It seemed like the most natural thing to say.
In this setting, we were located near the Marine base at Camp Lejeune. Many of the patients were affiliated with the Marine base but not all, obviously. I had some opportunity to provide treatment for those who were experiencing Post Traumatic Stress Disorder (PTSD) as a result of military experiences as well as victims of rape, domestic violence, and related traumatic experiences.
As I was saying above, I was treating those who had other disorders that had nothing to do with "trauma" per se, though that doesn't mean they never had anything traumatic happen in their lives. A person with Borderline Personality Disorder might today be diagnosed with Complex-PTSD or Developmental Trauma. This results from early life experiences that are characterized by dysfunctional home environments where a person is either neglected or is abused physically, psychologically, emotionally, or in some cases sexually.
I'm still shocked when I hear about children being sexually assaulted. We should all be shocked when we learn about such matters. We also should find physical, emotional, and psychological abuse to be unacceptable and it should never be minimized or trivialized, as my sister has done recently. However, the point I want to make is that in this position and all my work in the helping professions, I was dealing with a wide and diverse range of problems many of which are not directly labeled as a trauma disorder that is considered the presenting problem when they show up for treatment.
One incident that sticks in my mind was that of a soldier who seemed to be dealing with PTSD but as I began to explore his condition and symptoms further, it seemed that he had a condition that is quite different. He was demonstrating certain paranoid delusions and possibly hallucinations. At first, he was describing helicopters and it seemed like he might be describing incidents that related to his past experience in military combat. I would never imply that a person with PTSD or DID is crazy in any way.
Stating the idea that a person is out of touch with reality and confused can be understood by a person with a dissociative disorder or PTSD was a statement that they are crazy. This was a factor that would come up later when I was dealing with the various dissociative and PTSD conditions. In fact, the way they got so confused might have been a direct impact of their experiences with a less than competent or qualified "therapist" named John Freifeld - but I'm getting ahead of the story.
I was studying hypnosis and taking post-graduate continuing education training courses to advance my skills and this would never stop because I love education and it is required of professionals in the field. I pursued education and training in a wide range of therapeutic disciplines as well as psychological perspectives. I was passionate and dedicated to improving as a therapist. I wanted to be the best possible therapist. I wanted to have a wide range of tools to employ in helping others cope with their problems. I could never get enough education. I was nearly obsessed with learning - actually it was an eagerness that I had.
I thought about the collected knowledge and skills of those who came before me of those who were learning through their own experiences. If I had a deficit in my training and expertise, I sought to overcome that deficit and develop skills in that disciple or area, spending time toward acquiring those skills.
Any past uncertainties that I had about my competencies were facing away. By 1998, I had a great deal of confidence in my skills, abilities, knowledge, and expertise. I had acquired many social skills. I also noticed that the skills one needs to be effective with clinical hypnosis also are important communication skills.
Being effective in hypnosis also requires and sharpens one's sense of empathy and one's ability to mirror the feelings and outward responses of others. One can only infer the internal experience of another person based on a number of factors, such as the statements made by another person, their involuntary reactions, and a number of other observations. However, one should never assume to know what another person feels, knows, believes, or experiences within themselves. This is something one must confirm through communication with that person. That's why I have a pet peeve where I take issue when someone says "I know you know..." Or any statement that uses the phrase "you know."
At this position, working in Sampson County Mental Health, I was required to visit the Emergency Room or some other part of the local hospital to determine if a person was still a threat to their own safety. Often, they were in the hospital because they had attempted suicide by taking pills or through some other action. The hospital deferred to the judgment of the local mental health center and that meant they were deferring to my judgment on numerous occasions. I think they didn't want to go about the effort of finding a psychiatrist, taking out commitment papers, and such, so they contacted the Sampson County Mental Health Center.
I mentioned above that I didn't see eye to eye with the approach and how the mental health center was run. I mentioned that everything revolved around the doctor (psychiatrist), therapy wasn't valued enough, and the medical model was the default way of seeing people and their situation. Some people are assumed to be not able to benefit from psychotherapy but I was finding a way to get around that. With all this in mind, I can say that they never second-guessed my decisions when I made a visit to the hospital and decided whether or not someone should be committed to a psychiatric hospital for inpatient crisis stabilization.
I would indicate to the staff at the hospital that I was going to go to the magistrate and take out commitment orders. The police may or may not bring the patient by the mental health center to get the psychiatrist to sign off on the commitment order. There is nothing fun about being taken against your will to a locked psychiatric hospital unit. Being held in handcuffs is embarrassing when one is no danger to anyone else besides themselves.
Whenever one has to make such a call it doesn't mean that we are trying to hurt anyone or permanently take away their freedom and their rights. We know it is temporary. It's somewhat like calling Child Protective Services, which I had to do to ensure the safety of my brother, John Whealton's daughter. I didn't have it out for him nor is it realistic to think that he will lose his children as a result of my report. That's nonsense. We have to err on the side of caution in such circumstances. I can't say to myself, "well, I like my brother and he would not abuse his child." I had to err on the side of caution.
That's the way it is with taking out commitment papers. It's not fun for the person who is committed and taken by the police to a hospital but they understand. All of them had no problem continuing to receive treatment from me at the clinic. Yet, in the parallel situation with my brother, he disowned me because he spent a short period of time in handcuffs. And our parents never got to see me after that because they preferred to see my brother and his family and my brother, who had been my friend, decided that he never, ever wanted to see me again.
Getting back to the story, I did have to commit some individuals to the hospital. They continued to work with me upon return and my overall experience serving the clients was very rewarding and I had a great rapport. They knew I cared about their well-being and their healing. I was their advocate and supporter. I had been demonstrating empathy as well.
I didn't have the same positive experience with the staff and employees at the clinic and as I stated above the way they ran things made it hard to provide treatment and healing for others. I wanted to be available to everyone who had no other place to go other than a clinic like this. However, I couldn't be true to my values or find a way to use my skills in this position. Therefore I decided that the next step in my career was going to involve entering private practice as a Licensed Clinical Social Worker.
This was bound to work since I never had problems connecting with the clients or patients in any of my positions. In fact, I was gaining the respect and recognition of my colleagues.