[904] False Profits

It's been almost a month since I've thought to write anything for my adoring public. In that time, I've been banned from commenting on facebook for 30 days, gotten settled into being a counselor at a methadone clinic, and done feeble amounts of yard work, scrapping, or other chores in the intermittently nice days and inclinations that strike at random. It's nothing new that I don't know where to start.

I seem to find ways to make more and more money doing less. That was the thought I had finding a job where I can sit in an office all day, using “motivational interviewing” and “solution focused” conversational techniques to signify I have a basic respect and understanding of “where they are” when it comes to my “patients.” Depending on your “professional” distinction, you might have “clients,” but because you actually come to our center to get dosed, “pt” is the preferred descriptor. Suspiciously, “therapist” shows up on our internal sign-in sheet for staffing, and “counseling” and “therapy” are used almost inter-changeably by everyone but me.

The pragmatist in me gets it and even agrees, to some extent. I genuinely can't distinguish what any given psychologist is doing more than a person who is basically respectful and employing non-judgmental and curious language to get people to arrive at their own conclusions. I don't mean to be flip or deliberately blind to the exacting understanding or rehearsal of tools that advanced degrees require. I think there is enough room left for improvement in our understanding of the human mind and social environment to be suspicious that your problems rise to the level of hyper discipline-specific knowledge or medication most often.

I think that we even allow for institutions like the one I work for to exist in the first place is the realized truth of my pragmatism. Therapist shortage? Let's get into the tough conversation about what people really need. If you've managed to hold on for 4 years in service to a social-adjacent degree, you're it! Whether it's culturally imposed narratives or not, the feedback I get most often from patients is the insistence that “routine” or “structure” of having somewhere to be each day helps. I had a patient tell me she wanted someone to “call me out on my shit.” Culturally, we know we're all over the place. We prefer even the semblance of order over our internalized chaos.

Like many ill-equipped and poorly managed greedy dress-up games, they suffice to drop you in the middle and cross their fingers you'll make them more money than feel entitled to be paid. I was given ZERO training in how to conduct a group counseling session. I was given ZERO information on the nature of addiction, risks, or health implications of methadone. I was given ZERO reason to believe my “leadership” had anything more than a few letters after their name you can acquire after several day “training” workshops and taking a test for which you could be googling the answers to in real time.

What remains true at all times about this situation is the same across all situations. There are sincere people taking at least something seriously, even if it's not the kind of comprehensive long-term accountability that someone like me prefers. Everyone needs to be there, either to feel a certain kind of way, or be paid. The veneer of respectability is less something to bemoan and more to be understood as the playing field. Can you operate within the confines of what you've been given more than you destroy by virtue of what's missing? So far, it seems like I can, which feels obvious, but is no less generally disconcerting and sad.

It feels like one a job that I could never screw up as long as I was there. I turn on when I have to deal with people. If I'm tired or disoriented, I still have the capacity to direct or redirect the attention or language. I can set aside an hour here or there to type up any number of notes. I can nod along silently as someone who does not want to get better weaves webs of bitter bullshit and performs the story that precludes their ownership. I can do this dance until late July when I've hopefully paid off my debts and not found anything worth staying $1-3k in the hole for another month or two more.

In the meantime, I'm asking myself what I can do or speak to each day that will interrupt my tendency to...point out how wholly unfulfilling what I'm doing with my time is, deeply in spite, of any good I may do in service to any one person's life. A small proportion of people appear to take the process seriously. They communicate. They show up on time. They want their 6^th counselor in 2 years to perhaps give or teach them something useful. I'm not a “go through the motions” person. I will get bored, create something, try to do it in a new way, or take on more random shit to do that never made it into the job description. I need to find a way to actually stay awake after I get home and utilize the nice days before they are miserably hot. I need to bring food with me to eat throughout the day.

I'm, especially now, trying not to fall into a psychological black hole where I just kind of exist for the next few months, feel the clenching and weight lift little by little in two-week intervals, and remark 3 months from now just how “easy” or “obvious” my relative comfort or budgeting has manifested. A hidden opportunity, for example, was a patient who said her brother had 200 pallets he never knows how to get rid of each month or so. I can spend a few weeks transporting pallets in the bed of my truck, just like I've been making pilgrimages to Menards for cardboard to help fight needing to weed the garden. I'm also looking for some kind of preferred systematization that's both consistent yet spontaneous. If I owned my job and could take off or show up at will, like anything, I could see myself engaging with it indefinitely.

I intend to get as many letters after my name as they can bilk me for, with one conference/test in June on the calendar. I'll also be looking into gong into private counseling with a friend so we can court the hourly rate insurance actually pays verses what the middle men say we're worth. When I've got a blog on one screen, and a telehealth patient on the next banking me $150 an hour, we're going to have to start having some serious discussions about how that money should manifest in the world. By “we” I mean the 5 or so people who've actually bought into my designs for world domination.