ageing

With her 30th birthday just round the corner (up to you to picture how big that corner is), my female owner feels old and tired. She notices that her body and mind being less vibrant as before. Processing speed slows down. Memory becomes unreliable. Concepts float over her. Skin wrinkles. Body takes longer to recover. Fats pile on quicker than a Singaporean digging in at a buffet table – a lump of lard she calls herself.

Really, once she believed she would be forever young. She took it for granted that her body and mind would continue working as efficiently as how she had known them to function in her prime, her teenage years. Now reality hits home and ageing is the new game she has to play.

Could it be the effect of working in an aged care home? By the way, her charming resident passed away yesterday and my female owner is upset with the sudden turn of events. She was not mentally prepared for deaths.

contain

My female owner says that when God pours out His grace upon your life, it overflows and you cannot contain it.

Today, my female owner received an email from the clinic manager, with the title “proud of you!”. She thought it was a mass email to all interns, congratulating everyone on completing her (stinky) internship folios.

Turns out that it was an email written to her, and cc-ed to her CMI supervisor. The clinic manager wrote to inform my female owner that one of her clients was so impressed by the service provided by my female owner that she donated $200 to the clinic. The clinic manager added that in her years at the clinic, she never “had a spontaneous donation or such a great unsolicited testimonial”.

I suppose this gesture spoke volumes as the client is a full-time student who is working part-time to support herself. She presented to the clinic to get a neuropsychological assessment of her current cognitive functioning so that she could apply for disability services when she starts university next year. My female owner was the bearer of bad news as she had to tell her client that she has a learning disorder, with low average IQ, writing difficulties etc etc. Hence, to craft an email to the university (my female owner was not sure where it was addressed to, but the head of the school of psychology was the one who emailed the clinic manager) would have taken much effort on her client’s part.

It was also a public acknowledgement of my female owner’s interpersonal skills and professionalism. This is important in light of her CMI supervisor’s recent criticism that one of her shortcomings was her accent (as if she can change that) and understanding of local colloquialism. The gesture also provided more evidence for her that “she is not as bad as she thinks she is”.

shocks

My female owner has reverted to her junior college days, somewhat. She took a nap last night for 2.5hrs and ended up sleeping at 0600hr today. She woke up at 1300hr (slept through sunshine and renovation from outside and next door). Amazing sleepy head! In her junior college days (eons ago, apparently), she used to go home after school to sleep and wake up when it was dark and work through the night, before going to school. Upside down cycle indeed. My female owner is just more productive at night I think.

Anyway, she had a few shocks today.

Firstly, her Grandma client who used to torment her by not coming. She found out that Grandma’s 26 year old daughter (the one who forced Grandma to go for parenting programme with my female owner) is gay. It was shocking because she usually brings her three-year old daughter (through IVF) to sessions.

Seems like it is trendy these days for gay couples to procreate through IVF. My female owner has another female gay couple who came to her with issues concerning their three-year old daughter. Sounds similar, except that this mother is in her very early 20s. My female owner was also amazed at Grandma’s openness to her daughter’s sexual preferences (who disclosed her orientation 9 years ago).

While Grandma hated coming for those sessions early in the programme, Grandma is now willing to come by herself. Grandma and my female owner even had a little chat about how Grandma had changed over the past few months and Grandma said that what made her change was that my female owner was so nice. Hmm… no free sessions for saying that! She even shocked my female owner by recounting what my female owner said in previous sessions (my female owner always felt that Grandma was not fully engaged during the sessions).

The second major shock was that my female owner found out that one of her students in her tutorial had sought psychological help at the clinic. My female owner cannot put a face to the name but she recognised the name. The student had applied for an extension and attached the email to her assignment. My female owner wished she could do something to help her. She ended up writing a little note of encouragement/ acknowledgement before marking her written assignment. My female owner was impressed by the quality of her work, even though it was half-written. However, she could not pass the paper.

eureka

My female owner had a personal reflection session with her second supervisor today (S2). He pointed out that she seemed to be having problems with anxious clients and wondered what could be contributing to it.

My female owner reckoned that it was due to her “high personal anxiety” as her former boss once described. Her anxiety might have rubbed off the wrong way on her two anxious clients, causing them to lose confidence in therapy.

Does it mean that she will never be able to treat anxious people?

On the bright side, today, my female owner closed a 11-session parenting programme with a pair of parents whom she saw over the course of 4 months. This set of parents is the first to complete the full programme and they came out of it feeling satisfied with the outcomes. My female owner enjoyed working with them, even though there were times my female owner was certain that they would terminate on her (see her anxiety seeping into different aspects of her life?!). The Eureka look on their faces had been priceless, as they received revelations and answers to their child’s behavioural problems.

The greatest compliments given over the course of this programme was when the mother said that my female owner would make a great parent and even today, when she said that they should just bring my female owner home with them.

awkward

My female owner was traumatised today. She had supervision with her new clinical supervisor (yes, on a Saturday). Maybe I should give him a name, so that people don’t get confused. So let’s call him S2 (for supervisor number two).

My female owner’s latest anxious client told her that he started feeling anxious ever since his girlfriend told him that she had a one-night stand with a male acquaintance before they got together. That set off a series of negative feelings like betrayal, anger and anxiety.

Before I go off-track again, let me just say that the long and short of it is that, S2 recommended that my female owner takes a full sexual history from this 23-year old client, since he is presenting with sexuality issues (I shall leave out the details).

Yes, she felt as if she was being sent into the lions’ den. So S2 role-played the session with her being the client. Awkward questions indeed.

When did you recall having your first w_ _ dream? What happened after that? Did you try to hide the sheets or did you tell your mother?
Did you remember mast_ _ _ _ _ ing during high school? (my female owner had to step out of role to ask S2 what the typical answer was)
What about p_ _ _ ography? What kinds did you see? How often?
What did you do with your first girlfriend? Even though you never had sexual intercourse with her, did the both of you engage in f_ _ _ play, such as you touching her genitals and vice versa? What about o_ _ _ sex?

And the questions went on, fast and furious.

I think my female owner is very traumatised, because she jumped at the word "intimacy" just now, when someone used that word to ask her a question.

off-form

My female owner is trying to get into a regular work routine, i.e. to start work/ study etc at about 0900hr every day and end about 2200hr at night. There are, of course, lunch/ dinner breaks. That sounds like torture, coz it’s technically 11hrs a day (if you take away 2 hrs for meals). But she figures that she often has long breaks in-between clients and so, the actual number of hours of work she puts in is still about 8-9hrs a day.

She tried this again today and found it more exhausting than other days. Some reasons being, she really started working at 0900hr by calling a child safety officer. Then she rushed around trying to prepare for her supervision and three client sessions. Despite the early head start, my female owner found herself racing against time.

Her supervision session at 1400hr didn’t go well because she totally missed out doing a suicide risk assessment for a teenager who was brought in last week for a seemingly unrelated purpose. It was just that she talked about previous self-harm behaviour and my female owner did not pick up on that. Still, her supervisor’s reproach made her feel as if she committed the worst cardinal sin a psychologist can ever commit.

Then, her insomnic client at 1600hr did not improve her sleeping hours from the previous week but that’s probably to be expected since she had made most of the gains in the early parts of the therapy. My female owner didn’t know what else to do besides the usual stuff and ended therapy after 30mins. She was brain-dead, seriously.

Next up her schedule is her one-week old anxious client at 1715hr. For the first time, she was late for her appointment. After the 1600hr appointment, she had gone off to recharge herself in a small room but as usual, was slow in coming out. Anxious client was a charming young Italian lad. Oh, so cute. She perked up a little.

Finally, her 1900hr parent-client (of the teenager mentioned earlier). They came early and so she found them waiting for her after she closed off the previous client. Not much of a break there, but she loaded a parenting video for them to watch while she retreated to the small room to prepare for the session. Hurhur. Really last minute work.

Her session ended at 2030. Even then, she couldn’t go home, because she had to write case notes. Her remaining brain juice for the day allowed her to scribble some notes for the parent-client before she called it a night at 2130hr at the clinic. And you are so wrong, if you thought she went home. She headed to the library to borrow some treatment books.. and left only when the librarian announced that the library was closing.

There you have it… a long and off-form day, with some work still undone.. My female owner figured that it’s a bad idea to put three clients and a supervision session back-to-back but she don’t really have a choice, as she needs to “up her hours”. More on that tomorrow… I’m going to bed now. It’s a long entry and my little paws are tired.

unprepared

The male client called the clinic, looking for my female owner. My female owner had no choice but to return his call (she deliberately waited two days to do that). As expected, he tried to ask her out for coffee. Although my female owner predicted that this was the reason behind the call, she failed to prepare a good response. Again, she highlighted that it was an ethical issue and that it was not professional for therapists to go out with their clients. And the male client argued that he was no longer her client. So she had to explain that…. Ok, I’m not sure what she said, coz she gave a blurry explanation which went over my head. No wonder he was not convinced too. The tussle lasted for about 10 minutes and the male client finally gave up.

Hopefully he doesn’t call her again, or else things might become complicated.

breakthroughs

My female owner feels more competent this week, because she has achieved breakthroughs with two families.

First, the Grandma who kept cancelling on her and whom my female owner almost sacked, has finally demonstrated commitment to attending the parenting programme on a weekly basis no less!

The strategy which my female owner used was to overcome Grandma’s resistance and apprehension was to first, allow Grandma to ventilate and then reflect that she was listening to her. Next, my female owner asked questions that aimed to help Grandma see how the family environment was impacting on her grandson’s behaviour. She also used Grandma’s words to increase buy-in. That slowly convinced Grandma that some undesirable things were happening at home. My female owner realised that head-on persuasion was not going to win anyone over and the best way to modify mindsets was to guide the other party to generate his own truths.

The second family was a pair of parents who were very consistent in attending therapy and doing homework. However, they were still struggling with getting the child to comply and the mother kept saying that time-out didn’t work. My female owner had been feeling helpless and apologetic about the situation. She felt that she had not done a good job in teasing out the family’s issues and had this fear that they would terminate on her abruptly.

My female owner went to their house yesterday for a “practice session”. The parents had to select a typical situation which they struggle with, set some goals in terms of demonstrating some parenting strategies correctly and carry out the plan in vivo. It was my female owner’s first time carrying out a practice session for any of her clients (yes, this set of parents are the first to reach this stage of the programme). She found the session enriching in terms of her professional development as a therapist and also, in identifying gaps in their parenting. Phew. She left the session feeling that she had redeemed her credibility.

So there you have it. Two good sessions this week.

end

My female owner ended another therapeutic relationship today. Well, sort-of. The set of parents was one of her first clients when she first started her clinical work. They came to the clinic because they were having problems managing their 9-year-old daughter. Non-compliance, temper tantrums and laziness.

They are young and modern, obviously doing well in life. They are also expecting a baby in September. From the very beginning, my female owner had problems getting them to do therapy homework. They either claimed that nothing adverse happened during the week or that they did their homework but forgot to bring. Even though dad is not the biological father, he was more conscientious than mum. Nonetheless, they were both attentive and motivated, often quoting what my female owner said in the previous session (which my female owner obviously didn’t remember saying).

Anyway, in July, Yuppie Parents requested to take an extended break because they were in the midst of renovating and moving house. They said they would be back in mid-August. Today, my female owner decided to make contact with Yuppie Mum because she knew that Yuppie Mum was going to give birth. As expected, Yuppie Mum sounded flustered and disorganised but she eventually calmed down and spoke coherently to my female owner.

She was a little shaken when my female owner proposed closing their file in view that they would not be able to come into the clinic for quite a while and my female owner had to move on to another clinic. She was reluctant to continue with another psychologist and wanted assurance that my female owner would be able to pick up their case again when they came back. This was obviously something that my female owner was not able to promise but my female owner told her to call nonetheless when they are ready. Yuppie Mum went on to ask about my female owner’s holiday, school and future plans (crossing some boundaries here but that’s Yuppie Mum for you).

It warmed my female owner’s heart when Yuppie Mum told her that she had been a great help to them and that they would want to come in, even if it was just to say thank you and goodbye.

Ahhh… the perks of clinical work - knowing that you made a difference to a family.

boundary

My female owner just ended telephone therapy with a father client who was sent by the courts to attend a parenting programme at her clinic. Although she did not conduct the full-day training, her role was to carry out 4 weekly telephone consultations (30mins each) to guide him through the contents. The problem was that he was allowed 2hr supervised time per fortnight with his toddler daughter. Hence, there was nothing much about parenting that they could talk about during each telephone consultation.

Estranged from his wife and denied access to his daughter and possibly lonely, the client then started pouring out his life history to her. He happened to be involved in the same line of work with her, pursuing a PhD (sweat! My female owner can’t help but muse that she always ends up with clients who are more qualified than her. She had a previous mother client who is an academic staff in her field). In addition, he is currently working with juvenile youths in the forensic setting. Just her cup of tea.

Anyway, my female owner got the sense that he was getting too close for comfort during last week’s telephone consultation as he started asking her about her schoolwork and private life. This week was worse. Possibly because he knew it was going to the last session, he kept on talking his issues, repeating them over and over again, for an hour!

Well, my female owner, not one to interrupt or to cut short a conversation, found it really difficult to end the call. Ending the call was traumatic, coz when she ended with the usual “you can call the clinic if you want to come in to work through other issues”, the client asked if she would be the one attending to him. And when she said it depends on the allocation, he said that he hoped to be able to meet her for coffee one day and said “well, you have my number”. My female owner stammered through to say something along the lines that it was not appropriate but didn’t think that her message got through, coz he made her take down his email address.

My female owner can just imagine her supervisor marking her down for failure to handle boundary issues.