Why I became an adolescent psychotherapist

I used to think that life was all about advancement: ticking the right boxes, making the right contacts, doing the right things.

But this is the story of how I learnt to connect with young people and why I came to value that connection above my need for acknowledgement.

We are all influenced by the culture of success and ambition. We feel the need to achieve, to succeed and move up the career ladder to give our lives meaning.

It's a pretty skewed philosophy. 

I was one of the believers.

I thought if I could just work hard enough and get ahead, then I would be saved. I often look back and am amazed, and perhaps a bit surprised at my own single-mindedness. Everything else came a poor second to my ambitions.

When my academic job ended, I wasn't sure what step to take or where to go. It was a volatile period of questioning every assumption I had and every value I held dear. But it was also transformative.

I had always had a niggling thought, perhaps a hope that I could one day become a counsellor and I thought about studying art therapy or psychology. For many reasons, I eventually chose social work.

My first social work placement had been problematic and had caused me to question my commitment to my social work degree and to social work as a profession. After two false starts, I had found something that fitted, where I felt comfortable, supported and ready to learn the direct practice skills that excited me.

For my final placement, I explored many options, had a few possibilities fall through, cautiously considered and rejected others. Time dragged on and I ended up waiting months. Other students had long since gone off on their placements. Eventually, the field education leader rang me and offered an opportunity at a psychiatric inpatient service. Nervous and excited, I met with my potential supervisor who told me about her role and what sort of things I might do as a student there. I was offered the opportunity to do direct work with young people and to learn about mental health. It was exciting and a little daunting.

It was hard for me to be an intern, and there were many times when I felt overwhelmed, especially given I had left a role where I was in charge of staff and central to the running of a Department in a University. It was humbling. Now that a period of time has elapsed – I can see that it was an opportunity to gather life-changing threads of self-awareness, to see myself in a different light and start to create a new way of being. It was a hard lesson to learn, and not one many would choose to make at my age. I had chosen this path because I wanted to make a difference. I wanted to work with young people. But I didn't think it would be so painful.

With the help of my supervisor and colleagues, I found my feet at the hospital. I got to know the clinicians and the patients, went to ward rounds, attended meetings and sat in on groups. Eventually, with the help of my task supervisor, I was given a case-load. I became a valued part of the young person’s team and my practitioner self slowly blossomed as I came to let myself get involved in the things that really interested me.

Rereading my student workbook from this placement, I cannot help but smile at my naivety and my obsession with the theoretical, often at the expense of the real interactions and genuine emotions which I experienced – and witnessed. It was not, after all, me sitting there with a notebook and several heavy theoretical tomes waiting to diagnose or pinpoint a patient’s “problems”. I learnt that theory is only useful in so far as it can help us understand people.  I often just connected with patients and talked to them as if they were human beings rather than embodiments or manifestations of particular illnesses – or problems to be solved.  Perhaps it was a relief for them to chat with me, as I didn't have an agenda or a task and had time to just sit with them and be in their space wherever and however that was. I wasn't in a hurry to tick them off on my list and move on to the next customer. What I lacked in confidence and experience, I made up for in genuine willingness to engage - and curiosity.

The young people I saw in this environment were often struggling with anxiety, grief and loneliness. Underneath the surface of their illness, I could see other things – the lack of meaning, worth and value that seemed to have had such a devastating effect on their sense of self.

Some of these troubling thoughts and feelings seemed to end up inscribed onto their skin – many of the young people I met had long histories of self-harm; their painful scars were not always hidden by sleeves or neck scarves and their histories were not always as clear or discreet as their diagnoses (or their files) indicated.

As part of my regular duties, I was asked to meet with “Lisa.” (Not her real name). She had been allocated to me as a recent admission needing psychosocial assessment - a “meet and greet” of new patients.

I will never forget the feeling of walking into her room and seeing a beautiful, gentle young woman sitting on a bed lost in thought. Her sleeve, ravelled by the bedclothes, exposed a slender wrist shiny with healed burns. I was shocked and fascinated, curious and frightened of what emotions might be close to the surface. It was a melange of feelings I confronted many times during this placement.

My eyes diverted to the books she had resting on her table – this was something I could safely talk about. She had several art books sitting on a shelf, so we talked about art. I listened to her story and felt like crying. It sounded so much like my own. After training in her chosen profession, she found herself unemployed. She had applied for over fifty positions and still couldn't find work. It was a hard reality to face – one which many young people would find daunting, perhaps devastating. It had brought her face to face with her own fears and her lack of a stable sense of self. She was so genuine, so likeable and warm, that I wondered how she had missed out on so many jobs – the job market can be cruel.  She told me that too many students had been graduated that year. She was part of a cohort who had “flooded the market.” Employers were able to pick and choose, and people with no experience or contacts found themselves at the bottom of a very long list.  The lack of structure in her life presented a frightening echo of the lack of structure in her self – a black hole into which she fell - and fell apart. She had come back to the hospital hoping that containment would stave off the devastating depression which had previously overcome her.

I look at my “intervention plan” from my workbook and again feel discomfort at the inadequacy of the tools which I was encouraged to use in working with people. I remember at the time my reluctance to pigeonhole this young woman. I was probably just going through the motions of fulfilling the university’s requirements, but there is something so contradictory and, well, banal about directing a young woman at such a spiritual impasse into assertiveness training and employment coaching. If she got a job would that really solve her underlying problems or would it just temporarily distract her from the real work that needed to be done?

There were times during the placement where I felt such strong emotions that I needed to take time out. I saw (and felt) people’s wounds, scars and emotional pain. My own wounds were close to the surface – sometimes that helped me to understand, but there were many times when it got in the way.

I remember being stuck in a very small room with a very large young man whose unmediated feelings took up so much space that I felt like I couldn't breathe. I wanted to escape, but I didn't understand why. He was personable and intelligent, sensitive and generous, neither psychotic nor malevolent – why did I find it so hard to be around him? I still don't really know.

There were many other times where I just didn't have any answers.

I often tried to fill up the unknowable space with theory, hanging by my fingernails to some kind of structure when I felt myself at risk of getting lost in other people’s pain.

A month into the placement, I was allocated a young woman “Cathy” who had recently attempted suicide. She had been found in her car with a plastic bag and ligature, a bottle of whisky and a pyramid of sedatives. She didn't want to be here and very nearly wasn’t. When I met with her I was immediately struck by the way she described the sad wreckage of her life. Her face seemed calm, even at times amused, and laconic, as if underplaying the horror would make it alright for her, and perhaps more importantly - me. It was as if she didn't want to hurt my feelings or her own by being upset. The fear of being overwhelmed was always close to the surface, and the dark places she visited at night were not somewhere she wanted to go with me. She was closely monitored by the nurses and her room was regularly turned over and searched for razors or knives – with good reason. 

After my first meeting with Cathy,  I visited the nurse’s station to check her file and was helped by a nurse who turned to a page with the clinician’s summary.

Cathy was “Axis II” and the note in her file was underlined by the nurse with a pencil and a pursing of the lips.

She had been diagnosed with a personality disorder and placed unwittingly into the category of those whose behaviour is seen as manipulative and (perhaps more tellingly) taking up valuable clinical resources. She wasn't really “ill,” just twisted, indulgent, and demanding. All this was conveyed in a glance and gesture. It was the first of my many encounters in the private and public mental health systems with the judgement that accompanies a diagnosis of Borderline Personality Disorder – a potent label that’s hard for people to live down. Cathy had a long history of trauma and a recent bereavement. Her bad feelings made her vulnerable and she hadn’t developed good resources for self-soothing or emotion regulation. Did that make her a bad person or someone who didn’t deserve help?

I remember sitting with her while she worked on a jigsaw puzzle. She was perturbed by my presence, perhaps feeling that she needed to perform in some way or that I was somehow assessing her. There was an uneasy silence between us. I had made it to the other side of the professional/patient wall – but it wasn’t always a comfortable place for me. I could understand why she was wary and mistrustful. All the system had done was to judge and label her – keeping her safe, perhaps, but nothing really therapeutic had happened during her admission. She was given meds and close monitoring – that's about all. Perhaps that was all they could do given limited resources and the high level of risk she represented.

One patient I met during my placement (“Claire”) was threatened with being moved to the public system if she didn’t shape up. At one stage she was asked whether she really wanted to be bunkmates with a 60 year-old schizophrenic. I guess these threats didn't work, because she failed to get better and wound up in the local area public mental health inpatient unit.

 When I first met Claire, she was in bed playing with her phone. Her long black hair was spread across the pillow; she was also dressed in black – perhaps an outward expression of her feelings about herself. She was a troubled young girl with strong emotions and no ready language to make herself known or understood. Her desperately frightened parents had lost their other daughter to suicide the previous year.  They were uninsured, and had spent a fortune on bed fees for Claire at the private facility, hoping against hope that their remaining daughter could be saved.

Claire’s mother approached me after a meeting throughout which her daughter had raged, howling and swearing at both of us - and anyone else who happened to pass by. I found it difficult to know what to say. I told her that yes, I had seen worse behaviour and no, I didn’t think the situation was hopeless. It seemed to help.

Claire’s young psychiatrist had kindly taken me under her wing and allowed me to sit in on sessions.  Claire herself spent most of the family sessions texting or listening to music on her headphones. She seemed full of a hateful anger – vitriolic, dismissive, sarcastic and sullen in turns. She had, in her desperation, chosen non-verbal ways to make her feelings known. Her body and presence, her intense, unmediated affect swallowed up the room. It was hard to know how to help her.

The months I spent at the hospital were a time of learning and reflection. I made many mistakes and I also felt challenged in every way that it is possible to be. It was an intense time, but it was also exciting. I found myself confronted by the internal worlds of young people who were struggling with the most fundamental problems. Some of them allowed me in, some didn't, but to the ones who did, I will always be grateful. For all the effort and challenge of the time I spent in the hospital, I was more than rewarded by the young people I met.

They helped me discover what really matters.


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