Archives for posts with tag: clinical psychology

As you know, I arrived in North Carolina last Wednesday for some much appreciated vacation as well as to attend the first ever reunion of all classes from my clinical psychology Ph.D. program at the University of North Carolina at Chapel Hill. This is the first time I’ve traveled to NC on my own since my dissertation defense in 1997, which was a very short trip since I was still a psychology intern and needed to get back to work.

A five night trip with near total freedom in deciding my itinerary. A trip to a place I love. You know how James Taylor sings, “In my mind I’m going to Carolina”? He’s singing about Chapel Hill. His father was on faculty with the medical school. Chapel Hill is beautiful and song worthy. It is a relatively small city, dominated by a university, which is the oldest public institution of higher learning in the United States.

The first thing I noticed as I was driving from the airport to my friends’ house in Raleigh, was the countryside. The beautiful trees along the highway in their early stages of autumn color change. I noticed a glorious blue sky.

And then I saw them, the telltale V shape birds that pitch and rock when they glide. The turkey vultures were flying over the tree canopy. They are really interesting birds. They don’t live an elegant life. They are not smooth fliers and they scavenge for food instead of heroically gliding and catching fish that glint silver in the sun over the water.. I am not an ecologist but my guess is that despite their bad reputation, they are good for the ecosystem. In any event, with the exception of that apple tree attack in the Wizard of Oz, we don’t fear trees because they grow on decaying matter, some of it from animals, do we?

So one of my goals for this trip was to be mindful of places, people, and experiences. When I do this, I can find myself driving on one of the countless highways in the Raleigh/Durham/Chapel Hill area and waxing romantically about an ugly bird that eats dead animals. This is the power of mindfulness. I say this half-jokingly but it is true. Mindfulness can transform something ugly into something else.

Throughout my mindful trip, I noticed that mindfulness is on the mind of a good number of my North Carolina friends. Doris Ann Price, a lively, artsy, bright and fun woman was the first person I met with on my first full day in NC. Doris Ann and I met in 3-D for the first time last Thursday. She was diagnosed with breast cancer some time ago and made the awful transition to metastatic cancer several years ago. Doris Ann is famous in social media for wearing a button that says, “Cancer Sucks”, a pair of artsy/intellectual glass, her smart black and red wardrobe, and her bright red “Lady Danger” lipstick. (I learned that this is her nickname, something that a friend told M.A.C. Cosmetics about, which resulted in Doris Ann receiving a lifetime supply of their “Lady Danger” lipstick.)

I enjoyed interacting with Doris Ann on Facebook but I didn’t really know her. Contrary to somewhat popular opinion, extroversion is not a super power (nor is introversion an illness, for that matter.). I typically feel at least slightly awkward when meeting new people even when I am very much looking forward to it. Doris Ann and I hit it off right away and had a lovely time together filled with fun and meaningful conversation.

Doris Ann’s cancer has spread to her brain. This is something I knew about her. What I didn’t know it that her voice right now, is a few notches above a whisper because a tumor is pressing against her vocal cords. Her throat is also narrowed, making eating a lot process with very small bites.

Doris Ann was very genuine with me about the challenges that cancer has brought to her life. Despite this, she is a very lively woman who has found a way to keep joy in her life. She told me that she “moves forward” in life until she sees a stop sign. And then at that point, she stops, reflects, problem solves, and regroups. Doris Ann’s health is monitored quite closely by her oncologists and other healthcare providers. She is an upbeat person but certainly not a Pollyanna. Doris Ann is mindful of the seriousness of her health as well as the positives in her life. I admire her emotional strength very much. Plus she was fun and brought me very delicious gluten-free pastries as a gift!

A couple of days later, I found myself at my reunion. I immediately saw someone I knew, Don Baucom, a faculty member who had been the director of clinical training when I was a student. He was greeting people as they arrived. Don is a gracious and kind man with keen intellect and a wonderful sense of humor. He greeted me with a big hug and I felt a little less awkward about going to a party with people I had not seen for a very long time.

I loved graduate school but there was part of it that was like the longest adolescence a person can have that is actually healthy and not just living in your parents’ basement playing videogames, until age 30. The program was supportive but very rigorous and difficult. These were very smart and successful students. We had never had to work so hard to do well in school. So there was insecurity and competition on top of the competition that is part of any academic environment at a major university.

There were only two other people at the reunion from my class and very few from other classes whom I knew all that well. And only two of my professors were there. At one point, I thought, “maybe I’ll leave early.” Then I got my mind out of the past and into the present and proceeded to have a very good time reconnecting with and meeting people.

A couple of particularly lovely things happened. I heard a voice behind me say excitedly, “Elizabeth!” It was April Harris-Britt, who had worked in my dissertation lab, while she was an undergraduate student (I did not work on a professor’s project. I did an independent project, developing and evaluating a parent education program.) April was a wonderful student and I encouraged her to continue in psychology at the graduate level. She did and she entered the Clinical Psychology Ph.D. program after I left. She now has a private practice in Durham, NC.

“I was so excited to see your name on the guest list,” she said as she held my hand. “When I think about why I became a psychologist, I always think of you.” I gave her a hug, a kiss on the cheek, got a little teary and told her how awesome she was and is. Then we caught up on our lives. I saw a photo of her beautiful 4 year old grand-daughter.

This was a very moving encounter. I have found that since I started practicing mindfulness, I don’t feel as awkward showing affection that I genuinely feel. Now, I’m not going around kissing everyone’s cheek. Another part of my mindfulness is trusting that my own guesses as to whether someone would be comfortable with this, are pretty good. After all, knowing people pretty well is part of my job.

There was live bluegrass music at the reunion. They were very good. There was space for dancing but no one was out there dancing. I was sitting next to Sandra Zinn, a lively, brilliant, free spirited woman who graduated a couple of years after me. She said, “No one is dancing!” You know that I love to dance and I’m learning to get past my fears of being bad at partner dancing and just not care that I am bad at it. So I put out my hand and said, “Let’s go!” As I anticipated, Sandra accepted. We made up for lack of skill with enthusiasm, smiles, and giggling. About two minutes into the song, I started feeling self-conscious and told her, “I’m running out of moves.” She said, “It doesn’t matter as long as you keep moving.”

I have done a lot of things this month that would have been hard for me to do in the past. I have had 3 D encounters with three friends whom I met on the internet, one of whom is one of my very closest friends. (The third is the lovely, talented, and interesting Frieda Rosenburg, a retired UNC librarian. We had a marvelous time at the NC Botanical Garden and shopping at A Southern Season.) I have partner danced with two different people on two different occasions.

I am still not good at partner dancing. But it’s much more important to know how to live well than how to dance well. I still get nervous meeting new people or feel awkward in a crowd. But I am learning the difference between real stop signs and fabricated ones like the ones caused by social anxiety, perfectionism, and borrowing trouble from a future I can’t know until it gets here.

The fabricated stop signs are exhausting and when I make them, I miss out on a lot in my life. I don’t know how long my life will be or how many stop signs are coming up. In the meantime, I will live a life as mindful, meaningful, and as genuine as I can.

Doris Ann at Weaver Street Market in Carrboro, NC.

Doris Ann at Weaver Street Market in Carrboro, NC.

With Frieda Rosenberg at the NC Botanical Garden. Photo by Frieda Rosenberg, 2014.

With Frieda Rosenberg at the NC Botanical Garden. Photo by Frieda Rosenberg, 2014.

My dissertation adviser, Joe Lowman with alumna Sandra Zinn. This photo captures each of them perfectly! And do you blame me for asking Sandra to dance?

My dissertation adviser, Joe Lowman with alumna Sandra Zinn. This photo captures each of them perfectly! And do you blame me for asking Sandra to dance?

April and me. Did I mention that I am so very proud of April?

April and me. Did I mention that I am so very proud of April?

One of the things I am trying to do in my mindfulness practice is to be engaged and present with both my external and internal worlds. This requires awareness of myself, awareness of my surroundings, and awareness of people around me. When I am very engaged and aware, I have occasionally surprised myself with my behavior.

When I was an intern at the University of Florida, I was asked to interview a woman. She was about 50 years old. I was a child/adolescent track intern but all of us worked with children and adults, as part of our training. I remember that her hair was blonde. She had a nice hair cut but was disheveled in appearance. She was accompanied by her husband.

She cried nonstop. She was expressing suicidal ideation. I was accompanied by my supervising psychologist, who introduced himself and introduced me to the woman. Then he left the room. And then it was my interview to drive unless I made such a mess of it that my supervisor would have to take over for me. He would have to determine this from another room where he and a group of students were observing my interview.

I was nervous. This was not my forte. I write in all sincerity that I would have much preferred doing a four hour long test battery with a hyperactive 4 year-old. Yes, they are a challenge but they have a certain joie de vivre. And they still believe in magic and limitless possibilities. And they love my loud laugh and high energy.

This lady felt hopeless and helpless. She said she wanted to die. She didn’t believe in magic and limitless possibilities. My laugh and high energy were not what was needed. I felt out of my depth and out of my comfort zone. But like every other good trainee, I did my best to adapt and do my job.

In my hand was a writing pad and a pen. I looked at the woman. I saw the way she held my gaze. I heard the distress in her voice and her urgent need to be heard, really heard. I put the pad and pen aside. I looked into her eyes and we had a conversation, a long one for over an hour. The conversation included a suicide assessment, as was appropriate. But I had the strong gut feeling that she needed to talk to a person with free hands. I knew that I had a break right after the interview and at that time, my memory was like a steel trap. After the interview was over, I took my pad and pen and wrote nonstop for 45 minutes.

When I met back with my supervisor (this was my first case with him, by the way), he looked at me with an incredulous but not critical look and asked me why I had not taken notes during the interview. I gave my explanation, which appeared to satisfy him. We also compared our notes and he was impressed that I had gotten everything down. He told me that I’d done a wonderful job interacting with the woman. I worked with him a number of times during that particular rotation and I remember that he rated my skills very highly.

I would have never seen myself doing that before I made that quick but nonetheless considered, decision. I knew that I was supposed to take notes during the interview and depending on the particular question, follow certain interview protocols. I had always taken notes in the past. I knew that there were people watching me, including my supervisor.

I have taken notes during all of the interviews I have done subsequently, with the exception of interviews with young children. Those particular circumstances have never arisen again. And if they presented themselves to me again, I will probably take notes because my mind is no longer like a steel trap. But at that time, it was the right decision and I made it by being as fully engaged with that woman as I could even though I had been initially quite afraid that I didn’t know what I was doing. And perhaps by focusing so much on her, it allowed me to disengage from the anxiety and self-consciousness I had as a young trainee.

Like all professions, being a child clinical psychologist has its share of the good, the bad, and the ugly. Overall, the good greatly outweighs the rest. In the past week or two, this has been particularly true. As someone who primarily does psychological assessment, part of the news I deliver to parents is diagnostic. I give their children labels and sometimes multiple labels. Most of us don’t like hearing that there’s something wrong with our children.

Occasionally, parents get mad at me for this but more often than not, my message is greeted with GRATITUDE. Part of this has to do with what life has been like for the child at school and at home prior to the assessment. It has been hard or they would not be seeing me. Some of the kids I see have been kicked out of preschools and kindergartens. I saw a teen last week who’d been kicked out of daycare (as an INFANT), preschool, and ballet class, all before she started kindergarten. I see kids who work five hours a night on homework and their report cards are littered with teacher comments such as “needs to put in more effort”. I see parents who are so stressed out that they are barely able to hold back the tears in front of their children.

Sometimes, I receive gratitude from my patients, themselves. I don’t discuss diagnoses per se with my younger patients. They have to be old enough to understand it at a rudimentary level. They also have to be old enough to understand privacy and the risk of disclosing a diagnosis of ADHD or learning disability to others. Some people will be supportive, others will not. I do discuss testing results with older teens in detail and include diagnostic information. To teens who have been struggling for years with untreated ADHD and learning disability, been told that they are lazy, have told themselves that they are lazy and dumb, my giving them a different explanation of their challenges can be of great relief. As I have written in the past, it is a poignant moment when I tell a previously stoic looking teen boy that I know he is a hard worker, I know he’s not stupid, and the tears of relief roll freely down his cheeks.

But to define problems is not enough. People need a plan! I often say that the most important part of my assessment reports is the recommendations section. Out of a 6-9 page report, it is usually 3/4-1 page long. I have seen much shorter sections written by other psychologists and others that are so long and non-specific that they look like they’ve simply been pasted from another document without any editing according to the individual needs of the patient. I go over the report with parents and make sure that we discuss the recommendations. If I have a particularly high number, I make recommendations about prioritizing them and sequencing them over time. Finally, to make sure that parents leave with something concrete in addition to the report, I send them off with a packet of educational materials that I have selected just for them. And I put all of the materials in a pretty folder with my name on the front and my contact information on the back. This makes it less likely that the pieces get lost or that the nature of the contents of the folder is forgotten.

Last week I met with a mom of a delightful 7 year-old girl to go over testing results. Part of the results were plainly positive; this girl was a lot smarter than she seemed and much smarter than most. But I also gave multiple diagnoses. At the end of the session, the mom asked, “How many of these assessments do you do in a year?” I told her that I’m working part time this year but in the past that it was about 100-110. She said, “Think of all of those children you have helped! And you have helped my child already!” She left giving me a very big smile and a warm handshake.

At the beginning of this week, I received a payment in the mail from a parent of a teen I tested a number of months ago. It was a three session assessment including a parent/teen interview, five hours of testing, and a feedback session. In other words, it was a pretty time limited encounter that had occurred some time back. I could not remember the boy’s face. But his mother remembers me and put a note in with her check, “Thank you so much for your help with ____. You will never know how much it means to us.”

Today, I received the best note of all because it was from one of my patients, who I have seen for psychotherapy for some time now. It was a thank you card he sent me for attending his Bar Mitzvah during the summer. The main part of the message was very sweet but the postscript he added was the best, “P.S. Thanks for always being there for me. For everything.”

Thanks to all of you for your trust. Thank you for letting me into the most delicate and vulnerable places in your lives, your minds, and your hearts, in order to help when the only guarantee I can provide is that I will try my very best.

I told you it was a pretty folder!

I told you it was a pretty folder!

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