I have been working in methadone treatment since Sep 10, 2008. I started out working the front desk, taking money. Six months of hell later, I was promoted to a counselor. I was given a caseload the same day I began seeing clients as a student therapist. I worked for a greedy man who profited 3 million a year (yes, the foolish man let his accountant fax his tax return to the work address while I was standing there). Pay raises were irregular, but sneaked to me now and then when others didn't get them. The organization was obviously profit seeking and unprofessional, and when a new clinic opened last year, I made the jump. Note that my check bounced three times before I sent out my resume. Not that because he didn't have the money to cover payroll, but because he didn't leave anything in his business account. So the bouncing was due to carelessness, best I could tell. And over spending in his personal life. Islands in the Bahama's are not cheap, at least not to me.

The promised 3.5% annual raises, 4 weeks PTO, and six months after starting, the intern director said I would be groomed to become the director. My monthly stats are consistently 90% and above, I have taken on additional responsibilities, and work a lot of overtime to get the extras done as well as my own responsibilities. The director runs another 800 population clinic in another state. He's supposed to be in our clinic two days a week, but its more like 3-4 times a month. Recently I learned my promotion is not in next year's budget, there's no real plan to promote me any time soon, and the business owner says the director "overstepped himself" in offering me the promotion. My theory is the promise was just a way to get him out of our clinic several days a month, and that when things are running this well from a business perspective, there's no intensive to change. 

Worse, despite passing our national certification with no recommendations (meaning with flying colors), high marks on everyone's report cards, and all of our hard work (a new clinic is 20 times harder than one that's been open for 10 years, I now know), we were not given pay raises (all the other clinics they own got their raises, despite one's less than adequate performace); we weren't profitable enough? Since I track population and who's paying, I'd say it's greed. They wanted a profit and payoff this year despite some business decisions they made that cost the clinic). While I have many speculations (and facts) for why, I won't put them here. Unlike my previous clinic, I won't be given one quietly on the sly, either. While it is a much more professionally run clinic on many levels, the lack of raises and the promised promotion have broken my heart.

Put that on the back burner. Side note:

BTW the above is what happened to my blogging over the last couple of years. With the chronic fatigue syndrome, I was so thin I worked, slept, ate, and worked some more. My hobbies, my writing and my art largely went to the wayside. Due to financial constraints, we gave up cable tv and I haven't even noticed.

Let's get out another pot.

About six months the PD (program director) needed to hire another counselor. In methadone, the ideal caseload is 50 patients. Given that it's a new clinic, with the majority needing intensive time and attention, it should be much lower. We were up to 70-75. Since he was "training me" I helped go through resumes, we talked about hiring practices, and I participated in the interview. I was introduced to our future employee as the future program director. That obviously hasn't happened, and isn't happening any time soon and the people around me know it. Matter of fact, a new position was created for the business owner's pet, and she has been appointed the clinic "point person". The director assured me at the time it did not affect my promotion. Uh huh. I got a bridge for sale. 

Put that on the back burner.

So our new employee was contacted by one of her contacts in the field about a few positions coming open in several local practices. $40 an hour, 32 hours a week (in private practice you don't really get paid for the paperwork so 8 additional hours would be set aside for that). The particular opening that caught my interest is an a pediatrician's office (she is there one day a week).

Let's stir the pot. 

I took business practices in grad school. In fact, Cam came across my business plan a month ago or so. I had given up on the idea of private practice because I don't have the necessary local contacts. I'm not known in the community, don't hang out with doctors and other practitioners. Methadone's kind of a red headed step-child in the substance abuse and agency world. And the business owner was ready to hire me sight unseen because of my recommendations and previous training in child therapy. We graduated from the same school, had the same teachers and training. She knew what I knew. She even rewrote the contract to accommodate my needs.

Let's put it all together. 

I'm sitting on my deck, something I've only managed 4-5 times this year, blogging. I have a week's vacation. When I go back to work, I'll be working 5am - 1 pm at the clinic. Then half an hour away, I'll start seeing children in the afternoons 2-7. When they have 25 hours a week for me, I make the move full time. I start next Tuesday. Given that they already have scheduled 5 hours for me, I think it'll build. In fact, she needed 3 people for this office. Until the my caseload and one other's is full, she's not bringing on the 3rd, though she's been hired. Based on last year, she has no doubt she'll fill our schedules quickly.

I once dreamed about working with children and their families. That dream is about to come true. 

Burn Out: Crispy Critter

I thought that once classes ended, I would return to a normal schedule and rejoin the world of the living. I had looked forward to writing in my blog more, as well as many more important activities. I had underestimated the effect of four years of graduate school, the practicum, and working from 5am - 1pm five days a week, with occasional Saturday mornings thrown in. I've actually been getting up at 3:45 for more than two years for this job. A few years prior to this job, I worked as a fast food restaurant manager also getting up at the same hours to drive 45 minutes to work. The years have taken their toll.

Of course, rather than taking a vacation this year, we started Designs by Dreamweaver. I used every vacation day driving to festivals, setting up and selling. I used every minute possible in between festivals creating more jewelry. I estimate I sold over 500 pendants this summer, in addition to about 100 other items. Given that the pendants are made of polymer clay and labor intensive, that's a lot of work for $8 each.

So here I am, graduated from our Marriage and Family Therapy program, a licensed intern, and awaiting change. Cameron and I are expecting huge changes in our lives soon. My plan? I've secured a volunteer position at Rape Crisis/Safe Homes in our town where I'll do 5 hours of therapy a week in exchange for supervision. If  I increase that to 15, it would be sufficient to meet licensure requirements. So if our investment pays off adequately, I dream of working there as a volunteer for a couple of years...with more dreams to be discussed later once Cameron graduates.

In the meantime, I am a crispy critter. I did not realize how burned out I was until I realized that the exhaustion should have lifted with the end of festivals -- and hasn't. Of course, work is also extremely stressful. Holidays intensify addictions. I've also been chronically sick, with every cold my clients bring me and the return of my dysthemia. And our boss sold the clinic -- if the sale goes through. Without the payoff of this investment, it'll be a long time until I get time for a vacation. I'm due to gain two weeks Feb 2. That's when the new owners are supposed to take over -- I'll earn 4.8 hours paid time off per pay period with the sale. So much for the vacation!

So with all that I am, I am sending a call to the universe that our dream might be realized, that Cameron and I might have the financial means to fulfill our callings. I vow to sleep, rest, and serve until I am wholly healed, mind, body and spirit.

Blessed be.

Turn of the Spiral

First step: flashback

Invoke the usual "I was abused as a child" tale. My mother was diagnosed with Paranoid Schizophrenia. Never told the school counselor, whom I saw bi-weekly, what was really happening. Use your imagination.

My Diagnosis: Attachment Disorder.

First turn of the spiral: Pregnancy

Age 19. I loved my child. Received Christian pastoral counseling. No help. I was separated from my husband, pregnant by another man, taken in by an adoption agency and emotionally abused by a "shepherding father" who felt I was a bad influence for his teen daughters. Guess he expected a nice, contrite, never been married, didn't work kind of girl who would be grateful (meaning obedient). Received yet more counseling with different counselor. I fled, keeping my baby.

Second turn of the spiral

Age 20. Divorced from first husband, remarried the day before the baby was born to another young man with no idea of what he was getting into. He said he loved me. I was desperate. Living back home with the schizophrenic mother and codependent father. Two weeks later, moved 150 miles to where my husband lived. My husband never really understood what he had on his hands. I called it alcoholism (wait, don't I need a drunk-a-log for that? But alcoholics are just like me, except I never drank).

Diagnosis: Borderline Personality Disorder

Third turn of the spiral

Age 23. I have no more parenting/mothering skills than my mother had. I live in a town where I know no one. I stay at home with the baby. And with the next one. I convince my husband to join the church of my childhood. My husband works full time, and the romantic idea of a wife and ready made family doesn't match the reality. Received marital counseling. No help.
Husband's diagnosis: Major Depressive Mood Disorder, Chronic.

Forth turn of the spiral

Age 24. Desperation. Received individual counseling. I call child protective services on myself out of fear. I have a infant and a toddler, I am exhausted, depressed, strangling on inner emptiness and still isolated. I hear the anger in my voice. No one should yell at a three-year-old like that. I hit his diapered bottom too many times. I love my children, why is this happening? My husband is at a loss and has no clue. I call child protective services on myself. Child protective services can't see a problem and send me shopping (with what money? I have none) to get me out of the house for a few hours. They determine there's no problem.

Diagnosis: Post Partum Depression; Major Depressive Disorder, Chronic; Borderline Personality Disorder.

Fifth turn of the spiral

Isolated. I don't fit the Tuesday morning Women's Bible Study Group. They are kind, but carefully distant - perhaps judgemental. The minister brought us into the church, and abandoned us after orientation classes (after I had been baptized for the forth time). No friends. No family. Out of desperation, I create MAJOR DRAMA. My husband is self-righteously hurt, and I feel guilty and justified in leaving my children in his care...in reality, I am fleeing because I fear I might harm them, might become an abuser, even as I was abused. I surrender my children because of something I haven't done. They were not abused. I feared only that I might.

Cultural detail: Even today billboards in this state proclaim: Spare the rod and spoil the child. No wonder the church/child protective services didn't really see a problem. Or understand my fear.

Continual turns of the spiral

Married four times, divorced three times, widowed once, one broken engagement

Intermittent counseling, some help

Got my GED and then went on to college and received my degree in Bachelor of Sciences, major: English
Continued on to Graduate School

Segues: Extreme Marital abuse (3rd and 4th husbands)

Turn of the spiral

Discover Goddess centered spirituality.
Break old patterns and old habits...
Receive spiritual counseling. Tremendous help.

Move again.
Age 40: Come Out as Lesbian.

Enter into life partnership/marriage with Cameron - a healthy, stable loving relationship.

Fabulous Therapist...amazing progress. Much healing.

Return to Graduate school for a Masters in Marriage and Family Therapy.

Meaningful, powerful work as a Substance abuse counselor.

Diagnosis: Borderline Disorder burned out and passed, stabilizing, happy, strong - what diagnostic tools do we have for Mental Healthiness?

Turn of the spiral

Transformation: I know what I'm called to be: Lesbian, Priestess, Therapist

Today

I'm behind on supervision hours, as I was reminded in clinical evaluations yesterday. So Play Therapist Supervisor invited me to sit in her group supervision today. I didn't know until I arrived that the morning session had been devoted to completing the training of several play therapy supervisors and I was the Guinea Pig. She asks if I have a DVD of a play therapy session I have run.

Yes, I have a play therapy DVD. Yes, it's the one I turned in for my summer for class. Yes, I perceived it as the worst one I've ever recorded because I handled limit setting so badly.

Play Therapist Supervisor states it's nowhere as bad as I portray it. I don't believe her. She's just being nice, because she's like that, you know. So I play the DVD, proud that I'm calm while showing it to Play Therapist Supervisor, four licensed play therapists that are finishing certification this week for supervising, two Marriage and Family Therapy Interns, and one Marriage and Family Therapy student. And while I'm trying to tell them what I terrible job I've done, they are shaking their heads and offering amazing and insightful comments about how good it is. My supervisor says that I am one of her best student play therapists.

Then one of them offers a comment. He uses one of my favorite metaphors about time being a three dimensional spiral. As we circle around we reencounter old lessons, challenges ectera, but we encounter them at a new level and learn new things. He suggested maybe that's the process I was in while making the DVD and in how I perceive it. Then Play therapist Supervisor asks me: "Working from the framework as self-as-a-therapist, what old button does this video hit?"

In one blinding, clarifying moment I know why I have backed away from doing play therapy for the last three months. Because for one moment, for 1/10 of a second, I sounded like my mother as I struggled to lay down a boundary with a beautiful developmentally delayed three-year-old child. Before I got his name past my lips, I had heard my tone of voice and shifted. But all I remembered was that tone and the slump of his shoulders as I broke his trust with my "mom" voice. It had broken my heart. And although I caught it immediately, the limit then set appropriately, and reparation made, I carried that wound away with me. I clutched it to my heart, hidden and filled with pain. No true damage was done, yet my inner guilt from the past rose up to swallow me.

And in front of all those people, I looked at my supervisor, tears in my eyes, was handed a Kleenex, took a deep breath, asked for a moment, and told my story as briefly as possible. And I recognized that the past was blocking me with old pain and guilt. That I am actually good at child play therapy. That my peers think well of me and praise me. And that room full of therapists heard me, assured me, and offered this spiral of growth and healing.

Transformation and Sex Ed

The classroom lights have been turned off. My classmates have already left the building. Sex ed ended about half an hour ago. After going to get some food, I have slipped back into the building and headed for the computer lab. I feel a need to capture the energy of my experience and to share it before I go home to a dirty house, a dog begging to be walked, and the final exam that I need to complete and email to the teacher. This has been a week of transformation, not just for myself, but also for most of my classmates. We had 13 people in the class (two dropped early due to conflicts in their schedules). A local sex therapist was the instructor. She's everything I want in a teacher. Mature, on target, gentle, challenging, and ready for anything.

Let me back up just a moment and explain where I am coming from. After four marriages, three divorces and one committing suicide, I am in a committed relationship of six years with Cameron. I made a decision when I began this grad program to be openly gay and to use my presence to discomfort and challenge the heterosexual future therapists. I try hard not to offend, but I do not remain in the closet. There are a few therapists in the program, however, that make me uncomfortable enough not to have taken this class last summer when they would be there. That means I took the class with people I barely know.

My classmates ranged from twenty-something and just finished the undergrad to sixty-two and getting a new career. I was the oldest woman. I thought I was the only lesbian. The class really heightened my anxiety. Hearing about heterosexuality over and over again as we discuss erection disfunction, heterosexual couples issues, etc sometimes felt overbearing (it was, in fact balanced for the needs of our clients). We covered such topics as fetishes, BDSM, polyamoury, transgender, gay and lesbian issues. We read, we discussed, we watched videos. The instructor brought sexual aids, lube, and handouts. We role played, challenged, questioned.

Yesterday Cameron was invited to discuss what it's like to be caught in the middle of the gender continium. She made herself vulnerable to share with my class her challenges. She challenged their heteronormative assumptions. In the end, the class did a lot of soul searching and thinking. Then today SammieJoe came to talk to us. She's MTF. She's not flamboyant, or obvious, nor does she wear short skirts or too much makeup. She's also beautiful, feminine, and comfortable in her skin. She also arrived on her motorcycle wearing her pink helmet! And again my classmates rose to the challenge, asking questions, seeking to understand.

SammieJoe scared me to death. For a few hours I had to process the reality of Cameron's conundrum. I admitted to my future therapist friends in the breakroom the scariness of the something that can roll over a loved one's life, demanding transition, regardless of everything else. Today Cameron says she doesn't need to transition. But I know from listening to others that beneath the surface, the thinking can process and eventually come up with a different conclusion. And I know that no matter how much Cameron and I love each other, transition is ultimately her decision. Indeed, it has to be her decision. And while she would of course weigh the value of our relationship, she cannot ever choose me over something so profound. Nor would I want her to.

Once I named my fear today, I felt much better. And I realized how deeply my classmates lives have been touched by Cameron and SammieJoe. Several didn't even know what it means to be transgendered before this week. Others had simply never put a face to it. Our 62 year old future therapist said that he was doing a lot of soul searching because, despite what his baptist church might say, he believes in looking after his client' wellfare, and cannot see how SammieJoe could be wrong. I sit here in awe of the growth I saw in the class. The instructor praised us, saying we were one of the best classes she's ever taught. I don't doubt it. And I'm privileged to have been some small part.

Oh, I almost forgot the best part. We had to do the book report (see previous gripe about Barnes and Noble). A young woman stood up after me and said "When I went looking in my part of the store at Barnes and Noble, I couldn't find my books either." I looked up, suprised. Then she said, "I'm gay. I was going to talk about Lebian Couples, too. But since you've already done my book, let me tell ya'll about another." This beautiful, brave lesbian stood up in class to say she was gay. I am in awe. What tremendous courage -- she'll be in classes with everyone for the next two years. And she found the courage to claim her identity today.

Transgression of Binary Definitions: Gender Variant People in Marriage and Family Therapy

My supervisor told me yesterday that my paper for her Research Literacy class will be published shortly. She had to edit it to fit the journal. I asked permission, and received it, to publish the unedited copy here to my blog. My love to trans friends!

Many researchers have acknowledge the shortage of training in graduate programs for gender variant and transgender clients (Laird & Green, 1995; Long, 1996; Long & Bonomo, 2004; Long & Serovich, 2003; Ritter & Terndrup, 2002). Indeed, only fifty percent of marriage and family therapists report feeling competent to treat lesbians and gay men (Doherty & Simmons, 1996). It is unknown as to how many feel competent with gender variant clients. While public conversation has begun to accept the topic of gender variant people, society still treats this population as strange, exotic or alien (Laird, 2004; Lev, 2004).

Even among the professionals, before the DSM-IV, the medical field pathologized gender disorders as perversion, immature development stage or psychotic (Israel, 1997). These attitudes have placed gender variant people at risk emotionally and physically, including male victims of sexual violence (Cooks-Daniels, 2006). Moreover, clinicians report an increase in the number of individuals who describe themselves as transgendered that present for therapy (Feldman & Bockting, 2003, Lev 2004). As a result of these needs, Marriage and Family Therapists increasingly must familiarize themselves with the challenges faced by gendered variant people and their communities. In fact, marriage and family therapy is uniquely situated to meet this population’s needs, as gender variance does not occur in isolation, but in conjunction with other relationships, consequently affecting spouses, parents, children and community (Buxton, 2006; Lev, 2004).

In this post-modern era, the body has become a battlefield because of society’s determinism to define bodies as sexed either male or female (Costello, 1994; Cream, 1994). Gender variance includes persons who experience discomfort with their physical body and experience the desire to express the gender attributes of the opposite sex. In addition, for the gender variant person, the spaces where sexual orientation meets their gender identity can become quite complicated (Devor, 2002; Devor, 1993).

Early research in gender variance suggested that a greater number of men than women presented with gender dysphoria, possibly as high as 8:1 (Blanchard, Clemmenson, & Steiner, 1987). More recent research, however, suggests that that ratio is 1:1 and that women do not necessarily present for surgery at gender clinics, preferring to simply blend into society as “tomboys (Bower, 2001; Devor, 1997). Certainly not all transgendered people opt for full surgery. For example, “tranny boys” are lesbians who choose mastectomy but not hormonal or surgical intervention (Deogracias, Johnson, Meyer-Bahlburg, Kessler, Schober & Zucker, 2007; Lev, 2004; Devor, 1997).

Gender becomes a way to organize past and future cultural norms, allowing one to situate identity in respect to societal norms and live an active lifestyle based on the body one occupies (Webster 2002; Cream, 1994; Butler 1986). Finding a space in which to explore one’s gender can become very political; for example, some feminists protest that some gender expressions limit other possible gender meanings. Unfortunately, this stance can run counter to the feminist stance on marginalization and their attempts to give voice to those who have become disenfranchised (Heyes, 2003).

Attempting to create spaces in which to discuss gay, lesbian, bisexual and transgender issues led to the development of queer theory. Specifically, as gender variant people do not meet cultural binary expectations, according to queer theory, their identities constantly form and reform, thereby challenging heteronormative assumptions (Abes, 2007; Heyes, 2003; Johnson, 2003; Butler, 1986). As gender comes to be entirely socially constructed (Devor, 1993), this in turn becomes a challenge to heteronormative societal power structures (Longhurst, 1997; Foucault, 1978).

Rather than sex being equivalent to gender; sex becomes a physical characteristic and gender determined by a role played in society (Devor, 1993; Devor 1997; Butler, 1990). Gender then becomes not just a cultural construct, but also a performitive act in which one constructs self identity (Butler, 1986; Devor, 1993). Unfortunately, for all of these gender variant people, stepping outside of one’s assigned gender places one’s very existence into question because bending gender boundaries creates profound dislocation (Butler, 1986; Costello, 2006; Lev, 2004).

The act of recognizing oneself as transgendered can become a process carried over many years (Devor, 2004). At times, the incongruities between gender and sex can pose a danger to safety, for example, in public restrooms (Devor, 1987, Fausto-Sterling, 2000; Lev, 2004). When dissonance between self and culture heighten, gender variant people present in therapy with symptoms of excessive pain, agitation, guilt, restlessness and malaise (Lev, 2004; Schaefer & Wheeler, 2004). In addition, as gender variant teenagers move into adolescence, they report loneliness, depression and suicidal ideation (Devor, 1997; Costello, 2006). Furthermore, society silences the voice of gender variant children, assuming that they do not know enough about gender and sexuality to establish their identity (Costello, 2006).

To assist the gender variant community, therapists must change their image of gatekeepers and diagnosticians that judge, label, and possibly withhold surgical assistance to transgender and gender variant people (Behan, 2006; Devor, Lev, xxv). We must be aware of the shortcomings of the DSM-IV, which leaves out a number of diagnostically significant features (Bowers, 2001). For example, impairment of social function, a specifier in the diagnosis, is not present in every case.

Moreover, not every gender variant person needs or wants hormonal or surgical alterations (Fausto-Sterling, 2000; Lev, 2004). Recently published, the gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA) has been designed to aid clinicians in discerning an entire spectrum of gender idendities (Deogracias, et al., 2007). However, diagnostic labeling of gender variance has become both controversial and political. As transgendered people increasingly demand their rights, the difficulties of our diagnostic categories become more pronounced (Devor, 2002; Lev, 2004; Fausto-Sterling, 2000).

Therapists must educate themselves on the coming out process for gender variant people. Because the experience of “coming out” interrupts binary patterns of Western thought, much of our society fails to recognize that the process is not a discussion of sexuality but is a discussion of identity (Allen 1995; Lev 2004). As therapists, we must be prepared to work with people with gender variance and their families. We must build upon the incredible resilience that such marginalization requires (Allen, 1995; Laird, 1993).

It can take three to six years for straight spouses to recover from the shock and to accept reality (Buxton, 2006). A spouse’s coming out will create struggles with sexuality, marriage, children, identity, integrity and belief systems (Buxton, 2006). Therapists should never underestimate the commitment required of gender variant people or the pain and suffering they must endure, as well as the danger, violence or hostility they risk (Cream, 1994). Moreover, to deny one’s identity renders the person socially invisible (Allen, 1995; Devor, 2002; Lev, 2004).

Consequently, the “coming out process” becomes vital in the role of mental health for gender variant people and their communities (Behan, 2006). For young gender variant people, the families are often plagued with feelings of having done something wrong, or feelings of helplessness (Behen, 2006), making the role of the family therapist critical.

Family therapy has been slow to recognize the influence of sexuality in therapy, and in addressing the issues of gender variance on the family. Gender variant families can often be problem saturated, with struggles like heterosexual families, and with problems that go beyond those norms. Internalized homophobia, both within the gender variant client, their families and community add powerful stressers. With adolescents disclosing to their families, parents disclosing to the children, various system family therapies may be used (Long, Bonomo, Andres, & Brown, 2006).

Each of the various approaches, whether it be Bowenian, Solution Focused, Structural or Experiential, for example, offer possibilities and cautions (Behan, 2006; Long, et al., 2006). Perhaps the strength of each therapy lies upon the strength and sensitivity of the therapist. But if therapists are ill prepared, it has been suggested, that may because their supervisors are ill prepared as well. To address this need, Janie Long and Josephine Bonomo have created a matrix geared at addressing heterosexual bias and the degree of acceptance of GLBTQ orientations and behavior in both supervisees and supervisors (2006).

Acknowledging the lack of training for therapists in their respective programs, Long and Bonomo seek to create an opportunity for inward reflection for the self as a therapist in regards to those clients who exist in the sexual minority. As therapists establish themselves as LGBTQ allies, they become not only allies within therapeutic encounters but also with the community, counteracting stereotypes and homophobia that creates so much harm in gender variant communities (Lynch &McMahon-Klosterman, 2007).
 

References
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