The beginning of a hot summer day

     I awoke at 5:30 am, unable to sleep any longer.  What does today bring for me?  I placed a cup of yesterday's coffee in the microwave and went outside to smoke.  The fox scurried from my yard towards the woods and a deer reluctantly followed.  I walked around, looking at the plants and weeds I have growing, and thought of all the things I have to do.  I began watering the potted plants and set up the sprinkler for the ones in the ground and apparently the weeds surrounding them.  After a month, I see the deer discovered my sunflowers and on the some leaves were missing while others the entire tops were bitten off.  Pests!  The lawn needs mowed.
     The laundry has piled up, which meant for last week, pulling things from the back of the closet for work.  Clean laundry is piled up on the table by the washer and dryer.  Wrinkled now and only in the case of towels and underwear, needing only folding.  Sigh.  I vacuumed yesterday, but as is usually the case, the dogs seem to purposefully shed on the newly hair-free carpet.  I hate this carpet.  I would like to have wood floors.
     I turned on the tv and searched for noninfomercials that may be pleasing to distract me from my to do list or at least allow me to wake a bit before doing something.  I found background noise and went to my facebook.  Renee loves summer.  Hmm... and it is so hot I contemplate a move to Canada or Alaska.  This summer has been a series of plagues and tribulations.  The bees and wasps actually preceded the mosquitos which came in thick following the deluge of rain this summer.  Shortly after the mosquitos, the dragonflies hatched in abundance to eat them.  Poison ivy sprouted early as did my aversion and avoidance of it.  Two weeks ago, (or was it three?) frogs the size of flies jumped to avoid my every step down the driveway.  Yesterday a bat had attached itself to the front of the house.  What next Minnesota?
     I notice guilt in the form of medical bills piling up on the table.  They hide nicely the spot I spilled fingernail polish remover on about a month ago.  Collectors are calling, despite my payments to each of the medical institutions as I am able.  The doctor said I need to stop smoking.  This panics me.  I don't know why.  I am trying to ready myself, but designating a "quit day" is hard for me.  When I tell people, I get advice anywhere from what candy they used to acupuncture.  "Doc Jones" wrote me a prescription for the patch.  No one can tell me how to avoid the emotional crash I experienced the last time I tried.
     Doc Jones is an interesting creature to say the least.  He is a psychiatrist with a plethora of keys on a chain for each institution her serves.  He has an office across from mine though he is scheduled only one day a week there.  He has a fainting couch with blankets in there and an old car or truck door on his wall.  His inherited family doctor bag on the top shelf of his bookcase indicates the title "doc" has also been handed down for generations.  He sports a pony tail in his salt and pepper hair, giving a nod to the early '70s I suppose.  He is always running at 100 mph.  In addition to his psychiatry practice, he has an organic farm.  Who knows where he gets all of the energy to do what he does.  He still dictates his notes, a privilege of his title, I am sure, for the rest of us type our own.  At times he is short and curt, others he is jovial and sarcastic.    
     Yesterday I went to the Celtic Festival put on by Doc Jones at St. Matthias farm here in Brainerd.  It was sparsely populated with what appeared to be some of the more "different" people of the area - me included.  The smell of the peat burning lingered in my nose this morning.  The beer was cheap, but not quite cold enough to have two.  The music was good and two used books relating to Ireland joined my stacks of bills on the coffee table.  There.  Now I don't have to dust.
     After I poured my second cup of yesterday's coffee, I realized I needed to brew another pot for today.  Grumble.  I was not that ambitious.  Fatal loop.  Need liquid ambition to provide ambition for making another pot.  Hmm... I guess I will have to feign ambition for now.
     I know I need to go to work to get my stuff to work at home.  I just don't feel like showering but should in case I run into someone else just as behind in their work as I am.  I have several diagnostic assessments to do.  I get to label people so the insurance companies will pay for their therapy.  My new supervisor insists I write novels for each one as well as their treatment plans.  We get paid for one and one-half hours per DA and nothing for the treatment plan.  Even the most seasoned of therapists spends at least two hours on each.  I have been told there are people with jobs that actually don't spend their days off working.  That sounds wonderful.  I have also been told those hours accruing on my paycheck can be used for vacation.  That's an interesting notion but has a negative impact on productivity.
     I suppose I better get off my couch and be productive today.  I know I can't get caught up, but can pursue being less behind in my work at home and in my profession.  Do I really want to go to law school?  Still thinking about it.  I realize the sooner I start the sooner I will be done.  Right now I need more of a social life, or time occupiers, but can I handle that stress?  Perhaps I will ponder studying for the LSAT and see if it interests me.  They say it isn't what you know, but how you think that will get you through.  Still pondering as I pace through my rut...
 

And the Walls...

Last week I reached my breaking point.  I have been working week after week 6 or 7 days a week.  Easter weekend killed me.  I did not have time to work.  I got behind.  Then a week full of clients in crisis.  Parents who are so focused on themselves they ignore the strangulation marks on the neck of their child who attempted to end it all.

Therapy is tough work.  Tougher yet is the fact that they are turning a therapeutic model of practice into a business, almost production model of practice.  I am scheduled for 4-10 hour days.  Next week I have one free unscheduled hour.  Likely to be filled by a client in crisis.  If all clients show and don't cancel, I will likely meet productivity at the end of the week for the entire month.  For us, it is 23 hours of face time with clients.  It doesn't seem like much when you consider a 40-hour week, but we are required 8 hours a month of meetings with our supervisor and then there is the advanced clinical consult where we review specific troublesome cases with our colleagues.  Between face time with clients and meetings, we are making phone calls, meeting with other professionals, by phone or in person, writing lengthy diagnostic assessments, writing progress notes, and - if we are good - researching evidence based interventions for various diagnoses.

Insurance companies only pay certain amounts.  We get 1.5 hours for a diagnostic assessment which, when you consider the one hour of face time, leaves us .5 hours to review information retrieved from other agencies, enter PHQs, SDQs and CASII's and other measurements to further define our diagnoses, and write the assessment.  Even more fun is that I am on my 3rd clinical supervisor.  Each clinical supervisor has their own method of writing DA's.  Some want every detail and others want bare-boned diagnostic assessments.  Regardless, our overseer, the Department of Health and Human Services, has requirements that need to be met.  Basically with our assessments we need to establish a case for why our clients require therapy.  Suicidal clients make this easy for us.  Clients who wish to improve their marriage or otherwise work on their relationships make this more difficult.  We have to establish MEDICAL NECESSITY.  Sometimes this is difficult.

Last week I had 5 intakes.  Intakes usually require diagnostic assessments.  Even the best and most seasoned therapists admit that diagnostic assessments take them at least 2 hours outside of face time with clients.  I also had phone calls with clients' parents, school counselors, referrals to additional services, difficulties with the software we use for our documentation, meetings with guardian ad litems, reviewing additional court documentation, crises that require additional attention beyond the session and informal consult with fellow therapists on our clients.  My official work day ends at 7.  Some of my cases are so sick and twisted that I am affected by them.  Since I am the last therapist in the office I don't have anyone to debrief with.  Debriefing is so important when you are dealing with the mentally ill.  It helps so you don't take it on personally.  I don't usually have this opportunity since my day ends later than the other therapists.

So, there is a great deal of stress.  Then, our CEO, or whatever his title is, tells us that we have to meet productivity.  One of the clinical directors sent out an e-mail earlier this year stating if we don't meet productivity, we can lose our FTE (full-time employee) status.  This means we would be reduced to 32 hour status, lower pay and less availability for our clients.  I don't think we have any therapists that can possibly have openings in their schedule.  Where the problem lies is in meetings, trainings and cancellations.  We have no control over clients canceling.  This affects our productivity.  Next week I will be in the cities for 4 days for DBT training.  This training is to fill a need the agency has for people to work with clients with Borderline Personality Disorder.  These clients are referred to DBT groups facilitated by professionals and require a DBT therapist.  We have had therapists leave or quit doing DBT because of the intensity and extra (non-productivity) time required.  So, I lose 4 days of productivity.

In order to keep up on my paperwork, I now work Fridays, Saturdays and sometimes (like today) Sundays.  Since I am salary, I don't get reimbursed for this.  My pay is very low for a therapist since I am not independently licensed.  I need to supplement my income somehow.  This will probably involve working nights and weekend beyond my normal night and weekend work.  I am looking for something within my field to do this, since I think if my clients see me working at McDonald's it may affect my credibility.

Truth is, the bills are not getting paid.  I am getting notices from various medical providers threatening to turn the bills over to collections.  I did my taxes this weekend hoping I would get a substantial refund and this was not the case.

In summary, I am stressed out!  I am getting burned out at my job and now know I need to get another job to make ends meet.  I get angry with people who have taken money from me and still sleep at night!  A couple of weeks ago I learned that Brian closed my line of credit and overdraft protection account.  I was the primary account holder and was told he could not do this.  I will be changing banks soon, as soon as I have time!  When I work 8-7 M-Thursday and Fridays as well, there is not much time to call my creditors or stop in and close my accounts.  The line of credit could have helped with medical bills.  And then I get angry with the residual people who "don't have a problem with him" and continue to have their profile photos adorning his facebook page as friends and "like" his relationship with his new girlfriend living in the home I raised my children in.

Also stressful is that after working this week Monday -Thursday 8-7, I have to go down to MPLS for another procedure to burn my esophagus.  I am more anxious about this after having the last procedure and being unable to eat for 2 weeks.  I will stay with Renee overnight and head back to Brainerd on Saturday to pack for my 4-day training.

One big factor determining the success of our clients is their support system.  When I apply that to myself, I realize that I may have made a big mistake in moving to Brainerd.  I moved away from friends and family that were my support system.  I have a good number of friends here, but they are in different places in their lives, busy with families, children, schools, etc.

There is also the adage that you can't go back.  In several ways I found the truth of this statement when I went back for Easter.  The best part was that Mom remembered me.  The drive down is long and tiring.  It is about 7 and 1/2 hours to get to Sioux City.  I have difficulty with my "excessive daytime sleepiness" a.k.a narcolepsy and fight falling asleep anyway, but driving makes this worse.  I just can't do it.  When staying at Becky's I realized that I likely placed a wedge between myself and her family over Thanksgiving when I expressed my concern about the amount of stress and work she does with little help from Jeff or Hannah.  Jeff was either sleeping or gone the entire time I was there.  I get it.  Shut up Ande.  Don't worry about Becky and the burden she has that will take its toll on her.  I admire her, but I also realize her family has it easy by not helping her with even household tasks.  And I know she can't keep this up without it affecting her.  I also was mistaken in thinking my return might be special enough to prompt a visit by my brother and his family.  I could not take Monday off so I could be with my family on Easter Sunday because I have to meet productivity this month even with 4 days of training!  It is one day of driving each way. I have Fridays off, but then I don't get paperwork done and fall further behind if I am gone.

I Skype with Dad every Sunday.  This will keep us close.  Becky and I talk on the phone and that will keep us close.  I know I am the one who moved away and have accepted it is likely no one will visit me here.  I feel bad that I cannot return often.  Thanksgiving will likely be my next visit if I come then.  It is really dangerous for me to drive that long alone.   Maybe if I find someone willing to switch off driving with me I will be back more.  Right now, I have to say it is simply not likely I will return for some time.  It sounds like Mom is fading again, and perhaps it is best that I remember the her I saw on Easter.  I am so happy she held out that long.

In summation, I feel I am falling apart and running low on outlets and supports.  I realize this, too, shall pass.  I just wish it would hurry in its passing.

A Disturbing Dream

So I had a dream.  Not the MLK type.  I just wonder what Freud would have said about this one:

I was at my house in Sioux Falls collecting the remainder of my belongings.  Brian and his new girlfriend were allowing me to have whatever they did not want of my stuff - which is what happened in reality.  I was going through everything and found what was left was broken.  I was sifting tearfully through my broken and destroyed belongings and getting angry.  As I sorted, I kept seeing this large rack of cookie sheets full of pretty little cupcakes that Brian's girlfriend and her daughter were planning on eating.Brian's girlfriend would occasionally shout when I found something intact that I could not have it.  I looked around and saw salt and pepper shakers.  I waited until no one was watching me and sprinkled salt on the pretty little cupcakes.

Strange.

Pain

I have debated about writing about this for quite awhile.  I need to get it out and let it go.

In the summer of 2008 Brian and I were having problems.  He was seeing a woman from work and denied it - they were just friends.  Women are usually right when they get the sense their significant other is seeing someone else.  I admit, I invaded his privacy and went on his phone where I found x-rated pictures he had sent to her.  Strange friendship.  We took a trip to Bemidji shortly after this dispute.  While in Bemidji, Brian got drunk.  He verbally attacked me and my children.  It was verbal, but I felt it physically all over my body.  I cried so hard I puked.  My world, as shaky as it was anyway, was dark and murky.  I felt like escaping my body, but could not escape it or my thoughts.  No one had ever attacked me so vehemently.  I left him in bed the next morning as I packed all of my stuff to leave.  Despite my tip-toeing around, he awoke.  He begged me not to leave him there.  At that point I did not care how he got back.  Somehow, I don't know quite what he said, he talked me into not leaving him there.

Brian stopped seeing this woman.  Perhaps it was because his boss fired her - likely because his boss liked me and was upset about this relationship.  We went back to working on us.

One of the things that we both enjoyed was the Minnesota northwoods.  Particularly around the Ely area.  Brian had been saying that he wanted to move up there, and had interviewed up there for a job eventually.  I was concerned about family, especially his parents, since their health was declining.  Brian was set on leaving.  We would go back and forth about it and he said that I would never move.  He had interviewed for a job and was in contact with other job possibilities, but I had not.  He did not think I was committed to moving there.  I wanted to wait until Ben was out of school and in college at the very earliest and thought it would be better for him to wait until Jessica was graduated.  In early 2009 I had two acceptances to grad school.  One was for Vermillion for a PsyEd degree and the other was for the Social Work program in Duluth.  Brian urged me to go to Duluth.

I left for Duluth the day after we moved Ben to Vermillion to begin his college experience.  Brain said he would be up to see me often because he loves the area.  This did not prove to be the case.  In fact, shortly after I left for Duluth he began another relationship with another woman.  I did not find this out until Thanksgiving, I believe.  Jess and Brian got in a fight and she told me about it to hurt him.  To make matters worse, Brian completely dismantled Ben's bed and moved everything of his into my office.  Great!  Now Ben had nowhere to stay when he came back for college.  I was heartbroken.  Ben said he would just stay with his dad.  Ouch.  I love my kids and looked forward to seeing my kids when I was back.

By the time I was back for Christmas, the woman Brian was seeing broke up with him.  I was still angry with him and he expected me to be nice to him because he was devastated by his recent break up.  Another new development that began was the blame for everything Jess did.  I began hearing from both Brian and Jess that she was good before I came back, but was having poor behaviors when I returned.  Each time this occurred, I eventually found out she was acting out all along while I was gone.  I was a convenient scapegoat.  This was crazy-making.

By Thanksgiving 2010, Brian was back to attempting to get me back.  He bought me a new phone and stated he wanted to move up with me when I graduated and got a job.  He was ready to leave Sioux Falls and get away from Jess and his ex and the insanity that seemed to be their creation.  I hadn't decided if I would agree to that.  My choice was once again beside the point.  By Christmas 2010, Brian was seeing another woman.  He had invited me to a party of one of his work friends that I knew.  When it came time for the party, Brian uninvited me.  He had been acting odd all the time I was back.  He always took his phone with him.  He was texting frequently while I was there.  He came home late from work and was emotionally distant.

I was depressed.  The reason I attended school in Duluth was gone.  I had been trained in Minnesota child welfare laws and programs.  Much of this information would have to be replaced if I moved back. I was depressed.  I couldn't bring myself to do my homework in the last semester.  I was more depressed than I had ever been.  I began therapy and after working with my therapist for a few months, was finally able to get a semester's worth of homework done in 2 weeks.  I guess I would graduate after all.

Brian and I had put the house on the market.  The fair market value was $109,900.  The market was slow in Sioux Falls.  Brian and I discussed a settlement if the house did not sell.  There was $59,000 in equity on the house, with no liens on it.  Brian had only been making payments on the house since I left for Duluth.  Before that I made the house payment, utility payments, groceries, etc.  He had child support and car payments for his vehicle.  Basically, the equity was all mine.  Brian agreed to take out a loan to pay the me the equity if the house did not sell by May 1st.  By May 1st, the house did not sell.  Brian decided not to take a loan out.  He told me to rent a place.  I looked at rentals, but could not find one that would take 3 dogs.  It looked like I had to buy.  We argued on the phone, over and over.  Finally he said he could pay me $18,000 until the house sold.  But I would have to sign a quit claim deed, relinquishing my ownership on the house.  I told him I would do so if he promised he would pay the rest when the house was sold.  He agreed.

He took the house off the market in the fall.  By that time, his girlfriend and her daughter were living there.  He told me he would shut off my phone.  He said I could not go into the house for the rest of my stuff.  I had to tell him what I wanted.  I fought him on that and asked for my money since now they were all living there and the house was no longer on the market.  He refused.  He said he would never pay me the rest of my money.  So, he bought the house I raised my children in, built years of equity in, and remodeled over the years for $68,000 when it was valued at $109,900.  He somehow doesn't have a problem with that.  On top of that, I requested some of my stuff back.  One of the things was a wicker chair that my sons' grandmother gave me.  I had painted it, and reupholstered the chair.  It had been out on the porch.  When I asked for it back, he told me I could not have it because his girlfriend wanted it.  That made me mad.  This had nothing to do with her.  He had no right.  He also said he did not have my missing sapphire ring that had been in the jewelry box on the dresser.  I am assuming his girlfriend wanted that as well.

Okay, let us summarize:  Brian repeatedly cheated on me and made my life hell.  I would still be living around my family if it weren't for my proving to him I was committed to living with him by attending grad school in Minnesota.  I lost opportunities to see Ben when he was back from school, because he no longer had a place to stay with us.  I was cheated out of $41,000 from my house.  I gave 11 years of my life to this man.  I can't have any of my stuff that his girlfriend wants.  (I still have stuff over there).  

If anyone did anything like this to my family members, I would be livid.  Oddly enough, I hear from some of my family members, "I don't have a problem with him".  Really?  You don't consider anything he did to me or my children a problem?  Is that how we support each other?!  Recently I noticed that some of my family have "liked" his engagement on facebook.  If this all had happened to anyone in my family, I really would either have a lot to say, or nothing at all.  I certainly wouldn't consider myself his "friend" on facebook or anywhere else where obviously this would hurt.  But maybe you do have a problem with me?!

This was hard to write.  I got mad when I first heard that there was "no problem with him" and again when I saw the responses on facebook and decided not to say anything about it for 24 hours.  I have had to wait many more 24 hours.  Apparently my hurt is not going away anytime soon.